Filamentous thrombi during left-sided sheath-assisted catheter ablations

Abstract

This editorial refers to ‘Left atrial Lasso catheter thrombus aspiration’ by D. Sorajja et al. , Europace 12(10):1506–1507. Sorajja et al .'s1 case report highlights the problem of thrombi developing during a complex left-sided procedure in conjunction with the use of long sheaths. The dramatic growth in the number of catheter ablations for atrial fibrillation and other left atrial arrhythmias has brought into sharp focus the incidence of thrombo-embolic complications, most frequently cerebrovascular in nature. In a recent world-wide survey, cerebrovascular accidents including transient ischemic attacks and strokes were observed in 0.94% of patients.2 Typically, these embolic events may be the result of either dislodgement of a pre-existing intra-left atrial thrombus or the occurrence of air embolism or the generation of thrombus, coagulum, or char during the procedure. The probability of encountering a pre-existing thrombus in the left atrium can be diminished significantly by ensuring effective anticoagulation for 4–6 weeks leading up to the catheter intervention and excluding a transoesophageal echo detectable thrombus within the 24 h preceding the intervention. Despite an INR within the therapeutic range, the anti-thrombotic protection afforded by oral anticoagulants is unlikely to be 100% (more likely, 60–70%) and screening by transoesophageal echocardiography is a useful and effective second level of protection. During the procedure, air emboli can be easily prevented by adhering to basic … *Corresponding author. Tel: +41 22 3727202; fax: +41 22 3727229, Email: dipen.shah{at}hcuge.ch