Key result
Serial TEE with ultrasound-enhancing agents differentiates acute postcardioversion stasis from thrombus during LAA closure.
Why the study?
Acute postcardioversion left atrial appendage low-flow states are recognized but likely underdetected due to lack of routine repeat appendage imaging after sinus restoration.
Case Report (n=3)
Serial transesophageal echocardiography with ultrasound enhancing agents during LAAC procedures can identify acute postcardioversion stasis and distinguish slow flow from thrombus to safely guide device deployment.
BACKGROUND: Acute postcardioversion left atrial appendage (LAA) low-flow states are recognized but likely underdetected, as repeat appendage imaging is not routine after sinus restoration. CASE SUMMARY: Three patients undergoing left atrial appendage closure (LAAC) developed new LAA spontaneous echo contrast, dense spontaneous echo contrast/sludge, or a persistent filling defect suspicious for thrombus within minutes of cardioversion. Ultrasound enhancing agent distinguished slow complete opacification from a persistent filling defect, guiding individualized deploy-vs-abort decisions. DISCUSSION: LAAC uniquely permits appendage imaging immediately before and after cardioversion, and serial intraprocedural transesophageal echocardiography offers a rarely available window on acute LAA stasis. Alternative contributors, including ablation, transseptal instrumentation, and anticoagulation strategy, warrant consideration, particularly in combined atrial fibrillation ablation/LAAC workflows. Prospective studies should define prevalence, risk markers, and mitigation strategies. TAKE-HOME MESSAGE: Serial transesophageal echocardiography during LAAC can reveal acute postcardioversion LAA stasis; ultrasound enhancing agent can differentiate slow flow from thrombus and guide individualized deploy-vs-abort decisions.
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Ivanov et al. (2026) conducted a case report in Undergoing left atrial appendage closure (LAAC) (n=3). Left atrial appendage closure and cardioversion was evaluated on New left atrial appendage spontaneous echo contrast, sludge, or filling defect. Serial transesophageal echocardiography during left atrial appendage closure revealed acute postcardioversion stasis in three patients, with ultrasound agents differentiating slow flow from thrombus.
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