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  3. Thrombus entrapment with left atrial appendage closure to facilitate early cardioversion in tachycardiomyopathy: a case report.
 

Thrombus entrapment with left atrial appendage closure to facilitate early cardioversion in tachycardiomyopathy: a case report.

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BORIS DOI
10.48350/191245
Date of Publication
January 2024
Publication Type
Article
Division/Institute

Universitätsklinik fü...

Author
Bruno, Jolie Donna
Universitätsklinik für Kardiologie
Räber, Lorenz
Universitätsklinik für Kardiologie
Schnegg, Bruno
Universitätsklinik für Kardiologie
Primiceri, Livia
Universitätsklinik für Kardiologie
Subject(s)

600 - Technology::610...

Series
European heart journal - case reports
ISSN or ISBN (if monograph)
2514-2119
Publisher
Oxford University Press
Language
English
Publisher DOI
10.1093/ehjcr/ytad618
PubMed ID
38173782
Uncontrolled Keywords

Atrial flutter Case r...

Description
BACKGROUND

The aetiological spectrum of heart failure with reduced ejection fraction is various. Tachycardiomyopathy is recognized as one of the cause, usually made retrospectively. In this clinical context, rhythm control with restoration of sinus rhythm is considered crucial to minimize ventricular function damage and allow contractility recovery. However, the presence of a thrombus in the left atrial appendage is a limiting factor, typically requiring anticoagulation until the thrombus resolves, at least 3 weeks, thus delaying the therapy.

CASE SUMMARY

We present a case of 65-year-old man with diagnosis of new-onset acute symptomatic heart failure with severe reduced ejection fraction (left ventricular ejection fraction 15%), in the context of a typical tachycardic atrial flutter and concomitant thrombus in the left atrial appendage confirmed by transoesophageal echocardiography. We successfully performed a thrombus entrapment procedure by means of percutaneous left atrial appendage closure, which allowed immediate restoration of sinus rhythm through cavotricuspid isthmus ablation. After the institution of the heart failure therapy, titrated up to the maximum tolerated dose, we observed a complete restoration of left ventricular function after 6 months.

DISCUSSION

Thrombus entrapment by means of left atrial appendage closure is a valid strategy that enables early cardioversion with arrhythmia ablation and rapid restoration of normal cardiac rhythm in severe heart failure with reduced ejection fraction, even in acute situations and typical atrial flutter.
Handle
https://boris-portal.unibe.ch/handle/20.500.12422/173085
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ytad618.pdftextAdobe PDF779.89 KBpublishedOpen
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