Original Articles
Right atrial spontaneous echo contrast and thrombi in atrial fibrillation: a transesophageal echocardiography study*,**

This study was presented in part at the 10th Annual Scientific Sessions of the American Society of Echocardiography, Washington, DC, June 13-16, 1999.
https://doi.org/10.1067/mje.2001.108668Get rights and content

Abstract

Background: Previous studies have reported the clinical and echocardiographic findings of patients with left atrial spontaneous echo contrast (SEC) and thrombi. We sought to study these characteristics in patients with right atrial SEC and thrombi. Methods: We reviewed 580 consecutive patients from the ACUTE (Assessment of Cardioversion Using Transesophageal Echocardiography) Registry and found 79 patients (14%, aged 67 ±; 13 years, 67 male) with transesophageal echocardiography (TEE) findings of right atrial SEC or thrombi (group 1). This group was compared with a control group of 75 consecutive patients (group 2) (aged 68 ± 13 years, P = not significant; 49 male, P <.005) from the registry with no TEE findings of SEC or thrombi in the left or right atrium. Results: Atrial fibrillation was present in 60 of 79 group 1 patients (76%). Five right atrial (6%) and 11 left atrial (14%) thrombi were identified. Both left ventricular ejection fraction (39% ±; 16% versus 47% ±; 14%; P =.0005) and presence of right ventricular dysfunction (n = 44 versus 18; P =.0001) differed significantly between groups 1 and 2, respectively. Right atrial area (24 ±; 6 cm2 versus 22 ±; 6 cm2; P =.02) was larger in patients in group 1. Left atrial SEC was present in 68 of 79 group 1 patients (86%). Patients with right atrial thrombi and right atrial SEC had a longer duration of arrhythmia (524 ±; 812 days versus 147 ±; 368 days, P <.05) than patients with right atrial SEC only. Conclusions: Right atrial SEC has a prevalence of 14% in patients with atrial arrhythmia who undergo TEE-guided cardioversion. Right atrial thrombi are a rare finding and were seen in fewer than 1% (5/580) of patients with atrial arrhythmia. Right atrial thrombi among patients on anticoagulation therapy were not associated with clinically significant pulmonary embolism. (J Am Soc Echocardiogr 2001;14:122-7.)

Introduction

Clinical and echocardiographic findings and thromboembolic risk in patients with left atrial spontaneous echo contrast (SEC) and thrombi have been extensively studied.1, 2, 3, 4, 5, 6, 7, 8, 9 However, similar information about the right side of the heart is still relatively unknown.10, 11

Investigators have focused their attention on events involving the left side of the heart because of the association with embolic complications including disabling stroke. The paucity of information on right atrial SEC and thrombi may also be due to the difficulty in visualizing the right atrium in its entirety along with its appendage. Transesophageal echocardiography (TEE) with omniplane transducers has allowed better visualization of small structures in the heart including the right atrial appendage.

With the use of TEE, Manning et al12 found the prevalence of right atrial thrombi and SEC to be 10% in patients with atrial fibrillation. However, except for one study, echocardiographic characteristics of patients with right atrial thrombi have not been described.11

The goals of this study were to: (1) define the prevalence of right atrial SEC and thrombi in a large series of patients who have undergone TEE-guided cardioversion, (2) identify the clinical and echocardiographic features associated with these findings, and (3) identify the incidence of clinically significant pulmonary embolism in these patients who have undergone adequate anticoagulation.

Section snippets

Patient population

The ACUTE (Assessment of Cardioversion Using Transesophageal Echocardiography) Registry includes patients who are candidates for electrical cardioversion with a history of atrial fibrillation or atrial flutter of more than 2 days' duration. The registry was maintained for patients undergoing TEE-guided cardioversion who did not meet the inclusion criteria or did not consent to participate in the ACUTE Pilot Study or ACUTE Clinical Trial.4

We retrospectively reviewed 580 consecutive patients in

Right atrial spontaneous echo contrast

Five right atrial (6%) and 11 left atrial (14%) thrombi were identified in group 1. One of the patients had a thrombus in both right and left atria. Left atrial SEC was present in 68 (86%) of 79 patients in group 1. The variables that distinguished group 1 from group 2 included male sex, lower LVEF, larger right atrial size, and higher incidence of right ventricular systolic dysfunction (Table 1 ). A comparison between groups 1 and 2 showed that patients in group 1 had a higher prevalence of

Incidence of right atrial SEC and thrombi in atrial fibrillation

The results of this study have shown that in a large series of consecutive patients with atrial arrhythmia who underwent TEE-guided cardioversion, right atrial SEC was noted in 79 patients (14%). Of these patients, right atrial thrombi were seen in 5 patients (6%), which is fewer than 1% of the entire population studied.

Our results are in agreement with those of Manning et al,9, 12 who reported the presence of right atrial SEC in only 10% of their patients with atrial fibrillation, and right

References (20)

There are more references available in the full text version of this article.

Cited by (0)

*

This study was supported in part by an outcome research award from the American Society of Echocardiography.

**

Reprint requests: Allan L. Klein, MD, Desk F15, Department of Cardiology, The Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH 44195 (E-mail: [email protected]).

View full text
Copyright © 2001 American Society of Echocardiography. Published by Mosby, Inc. All rights reserved.