Left Atrial Appendage Thrombus in a Patient with Atrial Fibrillation on Apixiban Successfully Treated with Warfarin and Pulmonary Vein Isolation Ablation

Abstract

Atrial fibrillation (AF) is a common cardiac arrhythmia that can be seen in hospitalized patients.
It has been shown to be a major risk factor for cardioembolic stroke, and therefore patients
are frequently started on lifelong anticoagulation. The majority of patients benefit from either
cardioverison or pulmonary vein isolation ablation. We herein describe the case of a 58-yearold
male with a past medical history of atrial fibrillation surgery who presented to hospital
for elective atrial fibrillation ablation after failed medical therapy and persistent symptoms. A
transesphageal echocardiogram (TEE) prior to the procedure demonstrated a left atrial appendage
clot despite patient’s compliance with apixiban. Subsequently, the patient is started on
warfarin therapy with a heparin bridge. A TEE performed 6 weeks after discharge showed
resolution of the left atrial appendage clot allowing the ablation procedure to be successfully
performed.