Incidence of left atrial thrombi in patients in sinus rhythm and with a recent neurologic deficit

Objectives: We sought to determine the incidence of left atrial (LA) thrombi in patients in sinus rhythm (SR) and with a recent neurologic deficit and to analyze the relation between LA thrombi and LA chamber and appendage function in patients in SR. Methods A prospective study was conducted in 869 consecutive patients. The study group consisted of 583 patients in SR (67%). The remaining 286 patients had atrial fibrillation (AF) and served as controls (33%). Results The incidence of LA thrombi was significantly higher in patients with AF (n = 39 [14%]) compared with patients in SR (n = 6 [1%]; P < .001). Three of 6 patients with thrombi in SR had mitral stenosis, 1 patient had aortic stenosis, 1 patient had coronary artery disease, and another patient had a cardiomyopathy. Of the patients with detected thrombi, those in SR did not receive anticoagulation, whereas those with AF did in 18 cases. Patients with thrombi in SR and with AF did not significantly differ in LA diameter (5.1 ± 0.8 cm vs 4.8 ± 0.7 cm; 95% confidence interval [CI], –0.78 to 0.45), left ventricular ejection fraction (46% ± 13% vs 42% ± 15%; 95% CI, –18.7 to 7.4), LA appendage area (5.8 ± 2.7 cm2 vs 6.7 ± 3.2 cm2; 95% CI, –1.9 to 3.6), peak emptying velocity of the LA appendage (0.19 ± 0.08 m/s vs 0.17 ± 0.07 m/s; 95% CI, –0.08 to 0.04), or LA spontaneous echo contrast (3.5 ± 0.6 vs 3.9 ± 0.5; 95% CI, –0.06 to 0.45). Conclusions LA appendage thrombi are an infrequent cause of thromboembolism in patients in SR and are associated either with mitral valve disease or LA chamber and appendage dysfunction. Routine transesophageal echocardiography for the exclusion of LA thrombi is not recommended in patients in SR without underlying heart disease and normal LA function as assessed by transthoracic echocardiography. (Am Heart J 2000;140:658-62.)