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英文誌(2004-)

Journal of Medical Ultrasonics

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1998 - Vol.25

Vol.25 No.10

Case Report(症例報告)

(1005 - 1008)

電気的除細動による洞調律復帰後,抗凝固療法中にもかかわらず左心耳内血栓を形成した心房細動の1例

Left Atrial Appendage Thrombus Formation After Cardioversion of Atrial Fibrillation Despite Anticoagulant Therapy: A Case Report

清水 優美1, 田辺 一明2, 浅沼 俊彦1, 吉冨 裕之1, 小林 賀奈子1, 大野 美和1, 加藤 晴美1, 佐野 和也1, 石橋 豊1, 島田 俊夫1

Hiromi SHIMIZU1, Kazuaki TANABE2, Toshihiko ASANUMA1, Hiroyuki YOSHITOMI1, Kanako KOBAYASHI1, Miwa ONO1, Harumi KATO1, Kazuya SANO1, Yutaka ISHIBASHI1, Toshio SHIMADA1

1島根医科大学第四内科, 2Mayo Clinic

1Fourth Department of Internal Medicine Shimane Medical University, 2Division of Cardiovascular Disease and Internal Medicine Mayo Clinic

キーワード : Atrial fibrillation, Electrical cardioversion, Left atrial thrombus, Transesophageal echocardiography

A 72-year-old woman with atrial fibrillation was admitted the hospital for electrical cardioversion. Left atrial appendage (LAA) flow velocity recorded by transesophageal echocardiography (TEE) was 10 cm⁄s before cardioversion, and no thrombus was detected in the LAA. Anticoagulant therapy with warfarin was begun 14 days before cardioversion, and adequate stable prothrombin time was attained. Electrical cardioversion was performed, and sinus rhythm was restored with a shock energy of 100 joules. Follow-up TEE performed 4 days after cardioversion showed a de novo thrombus in the LAA, and LAA flow velocity (6 cm⁄s) was slower than before cardioversion. Anticoagulation therapy was continued, and TEE 18 days after cardioversion demonstrated that the thrombus had disappeared. There was no embolic event. LAA flow velocity increased to 30 cm⁄s. These findings suggest the necessity of adequate anticoagulation and follow-up TEE observation after cardioversion in patients with slow LAA flow velocity during atrial fibrillation.