Clinical and echocardiographic characteristics of left atrial spontaneous echo contrast in sinus rhythm

Sadanandan, Saihari; Sherrid, Mark V.

doi:10.1016/s0735-1097(00)00643-4

Cited by 95 publications

(73 citation statements)

References 26 publications

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“…21,[23][24][25] SEC was present in Ϸ45% of our patients with atrial fibrillation, which is slightly lower than described previously. 23,26 This can be explained by the inclusion of patients with intermittent atrial fibrillation in this subgroup.…”

Section: Clinical Implications Of Cardiac High-risk Sources In Teecontrasting

confidence: 61%

Therapeutic Strategies After Examination by Transesophageal Echocardiography in 503 Patients With Ischemic Stroke

Harloff

Handke

Reinhard

et al. 2006

Stroke

128

109

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Section: Clinical Implications Of Cardiac High-risk Sources In Teecontrasting

confidence: 61%

Therapeutic Strategies After Examination by Transesophageal Echocardiography in 503 Patients With Ischemic Stroke

Harloff

Handke

Reinhard

et al. 2006

Stroke

128

109

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“…Previous studies have identified spontaneous echocardiographic contrast as a marker of electromechanical atrial dysfunction and a risk factor for arrhythmia recurrence after DCCV. [9][10][11] We speculate that spontaneous echocardiographic contrast may identify patients with more advanced atrial dysfunction and hence a poor response to DCCV. Antiarrhythmic drug (AAD) therapy is an alternative or adjunct to DCCV for restoring sinus rhythm in patients with atrial arrhythmia.…”

Section: Discussionmentioning

confidence: 92%

Outcomes of Direct Current Cardioversion in Adults With Congenital Heart Disease

Egbe

Asirvatham

Kapa

et al. 2017

Journal of the American College of Cardiology

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Few data exist on direct current cardioversion (DCCV) in adult patients with congenital heart disease (CHD). This is a retrospective case-control study of 279 adults with CHD and 279 adults without CHD (control group) who had elective DCCV for atrial arrhythmias at Mayo Clinic, 2001 to 2013. Control patients were matched by gender and arrhythmia type. The objective was to compare DCCV procedural failure (failure to terminate the presenting arrhythmia) and arrhythmia recurrence (AR). In the CHD group (mean age 55 -20 years; men 166 [59%]), the most common diagnosis was Fontan palliation (61; 22%). Trans-esophageal echocardiography was performed before DCCV in 216 patients (77%); 162 (58%) had atrial flutter, and 117 (42%) had atrial fibrillation. Procedural failure and AR between the case and the control groups were more common in the CHD group (14% vs 7%, p = 0.01) and (83% vs 66% at 60 months, p = 0.001) respectively. There were no deaths or thromboembolic complications. The multivariable risk factors for procedural failure were Fontan palliation and spontaneous echocardiographic contrast; the risk factors for AR were Fontan palliation and atrial fibrillation. When patients with Fontan palliation were excluded from the analysis, the outcome of DCCV (failure and recurrence rates) was similar for the CHD and non-CHD groups despite the age difference between the cohorts. In conclusion, the present study showed that DCCV outcomes were similar for CHD and non-CHD patients, with the exception of patients with Fontan palliation.Atrial arrhythmia is common in adult patients with congenital heart disease (CHD), and the prevalence varies with lesion complexity and age of the patient. [1][2][3] It is associated with a higher risk of heart failure, ventricular dysfunction, and thromboembolic complications. [1][2][3][4] Restoration and maintenance of the sinus rhythm is therefore important to prevent these complications. 5 There are limited data on the outcomes of elective direct current cardioversion (DCCV) in adults with CHD. 6,7 A previous study 6 from our institution, involving a small cohort with limited follow-up, showed that DCCV is safe and effective in terminating atrial arrhythmia in this population. The present study involved a large cohort

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“…In a review of 1288 TEE studies of patients in sinus rhythm (1), the incidence of spontaneous echo contrast was 21%; 13% of these patients had an associated left atrial thrombus. All patients had an enlarged left atrium and reduced peak LAA emptying velocity (1).…”

Section: Discussionmentioning

confidence: 99%

Left atrial appendage thrombus in a patient in sinus rhythm with endocarditis and a severe aortic valve insufficiency

Shanks¹,

Čujec²,

Choy³

2008

Canadian Journal of Cardiology

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A 66-year-old woman with recently diagnosed monoclonal gammapathy of uncertain significance and no previous cardiac history presented to a tertiary care centre with confusion, aphasia, incontinence and right-sided weakness.One month earlier, she had been admitted to the intensive care unit with a diagnosis of sepsis. At the time, blood cultures had grown Hemophilus influenzae in one of two vials. She received a two-week course of intravenous antibiotics (ampicillin, metronidazole and ciprofloxacin). The source of the bacteremia was never identified. She was on no medications before her current admission.On this presentation, her vital signs included blood pressure of 115/54 mmHg, heart rate of 114 beats/min and O 2 saturation on room air of 99%. Her initial physical examination revealed expressive aphasia, right facial droop and right arm weakness. Her lungs were clear to auscultation. On a precordial examination, her first and second heart sounds were normal, and there was a systolic murmur heard at the left lower sternal border. She had no signs of peripheral edema.Her initial bloodwork showed a white blood cell count of 6.4×10 9 /L (normal value 4×10 9 /L to 11×10 9 /L), hemoglobin 92 g/L (normal value 120 g/L to 160 g/L), mean corpuscular volume 87 L (normal value 80 L to 100 L), platelets 258×10 9 /L (normal value 140×10 9 /L to 450×10 9 /L), international normalized ratio 1.2, partial thromboplastin time 29 s (normal value 24 s to 35 s), urea 11.4 mmol/L (normal value 2.5 mmol/L to 8.0 mmol/L), creatinine 85 μmol/L (normal value 40 μmol/L to 115 μmol/L), magnesium 0.82 mmol/L (normal value 0.7 mmol/L to 1.0 mmol/L) and troponin I 0.61 μg/L (normal value less than 0.15 μg/L).An electrocardiogram showed sinus tachycardia with nonspecific T wave changes in the lateral leads ( Figure 1).Computed tomography of the head confirmed a left middle cerebral artery territory stroke involving primarily the left insular cortex and a portion of the left frontal lobe.The patient was admitted to neurology. She was started on acetylsalicylic acid 325 mg daily, and was given intravenous fluids for dehydration.Within 12 h of presentation, she suddenly developed clinical and radiographic pulmonary edema. She was found to have a loud decrescendo diastolic murmur best heard at the left lower sternal border. Her troponin I level increased to a peak of 0.71 μg/L. Her clinical findings were highly suspicious for aortic valve endocarditis with severe aortic insufficiency and associated congestive heart failure. Due to her clinical deterioration, she was transferred to a cardiology service.Subsequent investigations included a helical computed tomography scan of the lungs, which revealed a filling defect in an anterior segmental branch of the pulmonary artery in the left upper lobe, suspected to be a pulmonary embolus. In addition, a round globular filling defect measuring 1.3 cm × 1.0 cm, which was suspicious for a clot, was identified in the left atrial appendage (LAA). No deep venous thromboses in the legs were seen. The patient wa...

show abstract

Clinical and echocardiographic characteristics of left atrial spontaneous echo contrast in sinus rhythm

Cited by 95 publications

References 26 publications

Therapeutic Strategies After Examination by Transesophageal Echocardiography in 503 Patients With Ischemic Stroke

Therapeutic Strategies After Examination by Transesophageal Echocardiography in 503 Patients With Ischemic Stroke

Outcomes of Direct Current Cardioversion in Adults With Congenital Heart Disease

Left atrial appendage thrombus in a patient in sinus rhythm with endocarditis and a severe aortic valve insufficiency

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