Safety evaluation of electrical cardioversion in the presence left ventricular thrombus

BACKGROUND: Electrical cardioversion is an effective and safe procedure for most patients. While left atrial thrombus is an absolute contraindication for an elective cardioversion, there is limited data on cardioversion in patients with left ventricular thrombus (LVT). We sought to better study the safety of cardioversion in this population. METHODS: We retrospectively reviewed all patients with the diagnosis of LVT on transthoracic echocardiogram (TTE) at our institution from 2010 to 2019. Patients were included in the study if they had undergone cardioversion and had had a TTE 4 weeks prior or 2 days after cardioversion showing left ventricular thrombus. Medical charts were reviewed for embolic events within three months after cardioversion. RESULTS: Out of 764 patients, 39 were included in the study. The mean age was 60 ± 14 years. The reasons for cardioversion were atrial fibrillation/flutter (n = 14), ventricular arrhythmia (n = 14), and defibrillation threshold testing during defibrillator placement (n = 11). The mean time interval between the TTE and the cardioversion was 6 ± 6.3 days. The mean left ventricular ejection fraction was 24 %±10 %. The LVT was mobile (n = 3), fixed (n = 36). During a clinical follow-up period of 81±17 days, 29 patients (74 %) were treated with warfarin, 2 patients (5 %) with a direct oral anticoagulant, and 8 patients (21 %) with antiplatelet therapy alone. No patient had an embolic complication during the follow-up. CONCLUSION: Within the limitations of this study, cardioversion in patients with LVT appeared to be safe. Further larger studies are needed.