PMC8558795_01
High ventricular response atrial fibrillation (AF) on admission electrocardiogram. Patient's electrocardiogram on admission showed AF with a high ventricular response and diffuse T-waves abnormalities. Electrocardiogram paper speed: 25 mm/s.
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Blood pressure was in the normal range, while electrocardiogram (ECG) showed high ventricular rate AF (Figure 1).
Left atrial appendage (LAA) thrombus on trans-oesophageal echocardiogram (TOE). TOE performed during hospital stay showed a mobile thrombus (4 mm x 4 mm) floating in the center of LAA (red arrow), contraindicating electrical cardioversion.
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Preliminary TOE revealed severe LAA smoke effect, low LAA velocity (<20 cm/s), and a mobile floating thrombus (4 mm x 4 mm) in the center of LAA, contraindicating electrical cardioversion (Figure 2).