Author + information
- Received May 4, 2012
- Accepted May 11, 2012
- Published online December 4, 2012.
We report the case of a huge left atrial (LA) thrombus formation during LA ablation. A single transseptal puncture was used as usual. The first St. Jude SL0 sheath was positioned in the LA and flushed and perfused with saline solution. The second SL0 sheath was positioned in LA using a 7-F deflectable catheter, passing through the previous puncture. This maneuver took a few minutes to be completed. As the contrast medium was flushed from the second sheath, a 30-cm long, bulky, mobile, “onion-ring” shaped thrombus floating into the LA was observed (A, Online Video 1). Intra-atrial systemic thrombolysis with alteplase from the first SL0 sheath was immediately started. The “onion-ring” thrombus quickly disappeared without any neurological or vascular sequelae.
It is possible that, despite the continuous saline solution infusion through the second SL0 sheath, a “cast” thrombus developed in the gap between the 7-F catheter and the 8.5-F SL0 inner lumen.
- Received May 4, 2012.
- Accepted May 11, 2012.
- American College of Cardiology Foundation