Delayed-onset atrial fibrillation following myxoma resection led to significant thrombus formation, causing an acute myocardial infarction in this patient.
This case highlights the diagnostic and management challenges of atrial thrombi causing embolic myocardial infarction following myxoma resection, demonstrating successful resolution with intravenous heparin.
A woman in her early 40s presented with an acute anterior ST-segment elevation myocardial infarction and new-onset atrial fibrillation (AF), 4 weeks after surgical resection of an incidental, asymptomatic left atrial myxoma. Preoperative CT coronary angiography was normal, and there was no history of AF.Emergency coronary angiography revealed complete occlusion of the left anterior descending artery. Percutaneous coronary intervention was unsuccessful at restoring coronary flow. Transthoracic echocardiography identified two large left atrial thrombi, and intravenous heparin was commenced. Surgical thrombectomy was considered but deemed to carry prohibitive risk. Serial echocardiography demonstrated complete thrombus resolution within 5 days.This case highlights the diagnostic and management challenges of atrial thrombi causing embolic myocardial infarction in the context of delayed-onset postoperative AF following recent myxoma resection. It underscores the value of multidisciplinary collaboration and the importance of echocardiography in aiding diagnosis and management.
Ng et al. (2026) studied this question. Delayed-onset atrial fibrillation following myxoma resection led to significant thrombus formation, causing an acute myocardial infarction in this patient.