Permanent left atrial thrombi after multiple atrial fibrillation ablations: Acquired Virchow’s triad?

Figures

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  Figure 1. TEE-1. A: Preprocedure transesophageal echocardiography (TEE) revealed multiple, mobile elements encircling the right upper pulmonary veins (RUPV) (white arrows). B: TEE-1 demonstrating 1.5 cm filamentous thrombus anchored at the ostium of the left upper pulmonary vein (LUPV) extending into left atrium (LA). AV = aortic valve; LAA = left atrial appendage.

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  Figure 2. TEE-2. A: Despite switching oral anticoagulation from rivaroxaban to therapeutic warfarin with goal international normalized ratio 2.0–3.0, transesophageal echocardiography (TEE)-2 demonstrated persistence of multiple left atrial thrombi (white arrows). B: TEE-2 showing fixed left atrial thrombus at the ostium of the left upper pulmonary vein (LUPV) (white arrow). LA = left atrium; LAA = left atrial appendage; RUPV = right upper pulmonary vein.

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  Figure 3. TEE-3. Transesophageal echocardiography after over a year of warfarin therapy with an elevated international normalized ratio goal of 2.5–3.5 demonstrating resistant thrombi. A: Image highlights a 0.47-cm thrombus adjacent to the right upper pulmonary vein (RUPV). B: Image displays a 0.56-cm thrombus at the roof of the left atrium (LA).