Clinical and Echocardiographic Characteristics of Patients With Left Atrial Thrombus and Sinus Rhythm

Background: Left atrial (LA) thrombus is infrequently
detected in the presence of sinus rhythm (SR) and, in these cases,
is usually associated with additional cardiac pathologies. We sought
to determine the clinical and echocardiographic characteristics of
patients with LA thrombus and SR to define a high-risk group of
patients prone to this uncommon clinical presentation.


Methods and Results: The institution’s echocardiographic
laboratory database was searched to identify patients with LA
thrombus, diagnosed by transesophageal echocardiography (TEE), who
were in SR during the TEE examination. Of 20 643 consecutive TEE
examinations performed during an 11-year period, LA thrombus was
detected in 314 patients in 380 TEE examinations. Of these, SR was
present in 20 patients (age 69±13 years; 40% men) in 23 examinations
(0.1% of all TEE examinations; 6.1% of TEE examinations with LA
thrombus). High-risk structural heart disease (severe left
ventricular dysfunction or significant left-sided valve disease
[predominantly mitral valve disease]), previous documented episodes
of atrial fibrillation, or both (structural heart disease and
previous atrial fibrillation) were present in 10, 4, and 5 of the 20
patients, respectively. Only 1 patient with LA thrombus and SR did
not have high-risk features.

Conclusions: LA thrombus is
very infrequently detected in the presence of SR. Patients with LA
thrombus and SR constitute a high-risk group characterized by
specific structural cardiac abnormalities or previous atrial
fibrillation, abnormalities that are potentially detectable before
TEE.

(Circulation. 2002;105:27.)