case_images: PMC10762891_01
case_images: Admission electrocardiogram: typical atrial flutter, heart rate 159/min, left axis deviation, QRS 89 ms, and QTc 456 ms.
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case_images: PMC10762891_01_ytad618f1.jpg
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case_images: The electrocardiogram showed regular, narrow complex tachycardia consistent with typical atrial flutter with 2:1 conduction (Figure 1).
case_images: (A) X-plane transoesophageal view of the left atrial appendage showing a left atrial appendage thrombus. Blue line: left atrial appendage walls. Asterisk: thrombus. (B) Left atrial appendage closure procedure: final radiographic image of the left atrial appendage occluder placement (Watchman device). (C) X-plane transoesophageal view (right) and 3D view (left) showing the deployed and released Watchman device in left atrial appendage.
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case_images: With the aim to proceed with an electrical cardioversion (ECV), a transoesophageal echocardiography (TOE) was performed, which detected a LAA thrombus (Figure 2A). We decided to perform a percutaneous LAAO using a thrombus-trapping technique with a 20 mm Watchman FLX (Figure 2B and C).
case_images: Discharge electrocardiogram: normocardic sinus rhythm, heart rate 91/min, left axis deviation, PQ 160 ms, QRS 90 ms, negative T-waves in I, aVL, V2-6, and QTc 444 ms.
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case_images: On the same day and separate intervention, a successful ablation of the CTI was performed with restoration of sinus rhythm (Figure 3).