A 59-year-old white woman with previous history of arterial hypertension consulted because of palpitations. Atrial fibrillation of uncertain duration was diagnosed. She was not receiving anticoagulants. A trans-esophageal echocardiogram was performed, and a large left atrial appendage thrombus was detected. A strategy of rate control and anti-vitamin K treatment was started. On the subsequent days, we could not reach therapeutic INRs. Therefore, it was decided to stop warfarin and initiate dabigatran. We describe the evolution of the patient, the thrombus resolution, and a successful electrical cardioversion. In our comments, we summarize the natural history of left atrial thrombus, both with and without anticoagulant therapy. We also discuss the differences between warfarin and dabigatran.

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25 of the 44 patients (57%) developed a vasovagal response or became symptomatic after 13.8 +/- 5.7 minutes of HUT. Three of the 18 volunteers (17%) had a vasovagal response and became symptomatic after 9 +/- 3 minutes of HUT. There was no statistical difference among the four groups (with and without tilt induced vasovagal response) in terms of age and baseline hemodynamic data. The sensitivity of 20 minutes HUT was 57% and its specificity was 83%. The presyncopal hemodynamic response in patients with history of syncope that was characterized by a significant decrease in systolic blood pressure and lack of increase of diastolic blood pressure as compared with baseline and with other groups.(ABSTRACT TRUNCATED AT 250 WORDS)

Outflow tract pacing appears to improve medium- and long-term survival. Prospective randomized trials with a greater amount of patients are necessary to confirm the findings of this study.

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