Author + information
- Received April 2, 2018
- Revision received April 23, 2018
- Accepted April 26, 2018
- Published online August 20, 2018.
- Kanae Hasegawa, MD, PhD,
- Shinsuke Miyazaki, MD, PhD∗ (, )
- Kenichi Kaseno, MD, PhD,
- Naoki Amaya, MD, PhD and
- Hiroshi Tada, MD, PhD
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, University of Fukui, Fukui, Japan
- ↵∗Address for correspondence:
Dr. Shinsuke Miyazaki, Department of Cardiovascular Medicine, Faculty of Medical Sciences, University of Fukui, 23-3 Matsuokashimoaizuki, Eiheiji-cho, Yoshida-gun, Fukui 910-1193, Japan.
Right ventricular (RV) thrombi are quite rare. The appearance of a giant RV thrombus following an ablation procedure has not been reported.
A 23-year-old woman with drug-resistant, frequent multifocal premature ventricular contractions (22,487 beats/day) underwent catheter ablation. Pre-procedural echocardiography revealed a normal ventricular function, but a localized aneurysm with dyskinesis was observed in the RV apex on echocardiography, computed tomography, and cardiac magnetic resonance imaging. She was diagnosed with arrhythmogenic RV dysplasia. No intracardiac thrombi were detected on those 3 modalities prior to the ablation.
The activated clotting time was maintained between 200 and 300 s throughout the procedure. Radiofrequency (RF) energy was applied at the sites of the premature ventricular contractions’ origins, including the RV inferior wall and apex within and at the vicinity of the RV aneurysm with an irrigated-tip catheter. The total application time was 51 min, and total amount of RF energy 98,677 J. Intravenous heparin was administered for 24 h after the procedure, and then she received antiplatelet therapy for 1 week. Echocardiography did not detect any intracardiac thrombi by 2 days post-procedure.
One month later, a routine follow-up transthoracic echocardiography revealed a giant mobile thrombus (26 × 10 mm) within the aneurysm in the RV apex (Figure 1A, Online Video 1). Anticoagulation therapy was immediately initiated, and the thrombus disappeared 1 month later on follow-up echocardiography (Figure 1B, Online Video 2). During 2 years of follow-up, no thrombi reappeared in the RV aneurysm on echocardiography without any anticoagulation therapy.
The link between endothelial damage and thromboses following RF ablation has been reported. The underlying mechanisms leading to the process of thromboses are thought to be a hypercoagulable state owing to extended endocardial injury and inflammation post-RF ablation in addition to anatomic predisposition (1,2). The present case highlights that routine anticoagulant therapy should be considered during the early post-procedural period in patients undergoing ablation in aneurysmal regions.
The authors have reported that they have no relationships relevant to the contents of this paper to disclose.
All authors attest they are in compliance with human studies committees and animal welfare regulations of the authors’ institutions and Food and Drug Administration guidelines, including patient consent where appropriate. For more information, visit the JACC: Clinical Electrophysiology author instructions page.
- Received April 2, 2018.
- Revision received April 23, 2018.
- Accepted April 26, 2018.
- 2018 American College of Cardiology Foundation