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EP News: Case Reports

  • T. Jared Bunch
    Correspondence
    Address reprint requests and correspondence: Dr T. Jared Bunch, Division of Cardiovascular Medicine, Department of Internal Medicine, University of Utah School of Medicine, 30 N 1900 E, Room 4A100, Salt Lake City, UT 84132.
    Affiliations
    Division of Cardiovascular Medicine, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah
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Published:September 02, 2022DOI:https://doi.org/10.1016/j.hrthm.2022.08.038
      Catheter ablation for atrial fibrillation (AF) is more effective than drug therapy. In patients with persistent and long-standing persistent AF, additional ablation is often required that can compromise mechanical function that can lead to long-term morbidity. Ali et al (https://doi.org/10.1016/j.hrcr.2022.07.015) shared a case of a 72-year-old man with a history of 3 prior ablation procedures for symptomatic AF, including multiple linear ablation procedures in addition to pulmonary vein isolation. Three years after after his last ablation he presented with recurrent atrial tachycardia on sotalol 80 mg twice daily and rivaroxaban 20 mg daily. He was referred for repeat electrophysiology study and attempted ablation. A transesophageal echocardiogram identified multiple mobile masses consistent with thrombi in the left atrium, with one measuring 1.5 cm between the appendage and the left superior pulmonary vein. The attempted ablation procedure was aborted, and anticoagulation was switched to warfarin. Three months later, the thrombi persisted and he was switched to enoxaparin. Three months later, the thrombi remained and he was transitioned back to rivoraxaban. Serum testing for a hypercoagulable state was unremarkable. These data highlight important risks with extensive ablation that compromise mechanical function.
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