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Post-cardioversion Atrial Stunning -- Not to be Forgotten
  • Tasneem Naqvi,
  • Merve Kurt
Tasneem Naqvi
Mayo Clinic Scottsdale

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Merve Kurt
Mayo Clinic Scottsdale
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We present a case of a 60 year old male who found to be in atrial fibrillation during routine evaluation. Anticoagulation was initiated for 36 hours and he was referred for TEE guided electrical cardioversion. There was no thrombus identified in the left atrial appendage, however the appendage was large and had a tongue like accessory lobe along with spontanous contrast on the left atrium and its appendage. TEE probe was not withdrawn, patient underwent successful cardioversion with 200 joules and developed a thrombus in the left atrial appendage immediately after cardioversion, which rapidly became more dense. There was an associated marked decrease in appendage velocities. Patient was hospitalized to initiate low molecular weight heparin. This case highlights the need for vigilance in patients with unknown duration of atrial fibrillation, who have received a short duration of anticoagulant therapy and who have adverse appendage anatomy as thrombus may develop immediately after cardioversion despite anticoagulation.
29 Aug 2022Submitted to Echocardiography
22 Sep 2022Submission Checks Completed
22 Sep 2022Assigned to Editor
01 Oct 2022Reviewer(s) Assigned
02 Nov 2022Editorial Decision: Revise Minor
10 Nov 20221st Revision Received
10 Nov 2022Submission Checks Completed
10 Nov 2022Assigned to Editor
12 Nov 2022Reviewer(s) Assigned
04 Dec 2022Review(s) Completed, Editorial Evaluation Pending
10 Dec 2022Editorial Decision: Accept