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 fun ction 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 patien ts had atrial fibrillation (AF) and served as controls (33%). Results The incidence of LA thrombi was significantly higher in patients wi th AF (n = 39 [14%]) compared with patients in SR (n = 6 [1%]; P < .001). T hree of 6 patients with thrombi in SR had mitral stenosis, 1 patient had ao rtic stenosis, patient had coronary artery disease, and another patient had a cardiomyopathy. Of the patients with detected thrombi, those in SR did n ot 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 cm(2) vs 6.7 +/- 3.2 cm( 2); 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 spontaneou s 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 L A chamber and appendage dysfunction. Routine transesophageal echocardiograp hy for the exclusion of LA thrombi is not recommended in patients in SR wit hout underlying heart disease and normal LA function as assessed by transth oracic echocardiography.