Resolution of oral anticoagulation-resistant left atrial appendage thrombus by cardiac resynchronization therapy and atrioventricular nodal ablation

Abstract

We present a case of congestive heart failure with reduced ejection fraction complicated by atrial tachycardia and an oral anticoagulation-resistant left atrial appendage (LAA) thrombus. The LAA thrombus prevented sinus rhythm restoration, and the ventricular rate control was also difficult. Cardiac resynchronization therapy (CRT)-defibrillator implantation followed by atrioventricular nodal ablation was performed, and the patient's congestive heart failure improved. Furthermore, the resolution of the LAA thrombus was achieved three months after the implantation. The atrial tachycardia was eliminated by catheter ablation thereafter. This case highlights the importance of improving congestive heart failure for the resolution of LAA thrombus and the potential usefulness of CRT with atrioventricular nodal ablation for this strategy.

Learning objective

Treatment strategies for patients with decompensated congestive heart failure are difficult, especially when complicated by atrial tachyarrhythmia and left atrial thrombus. Cardiac resynchronization therapy with atrioventricular nodal ablation may be a possible solution not only for the improvement of heart failure but also for the resolution of left atrial thrombus.