Early Left Ventricular Thrombus Following Ventricular Fibrillation/Ventricular Tachycardia Electrical Storm

  • Ramez Alyacoub Department of Internal Medicine, Rutgers NJMS/Trinitas Regional Medical Center, Elizabeth, NJ, USA
  • Sherif ElKattawy Department of Internal Medicine, Rutgers NJMS/Trinitas Regional Medical Center, Elizabeth, NJ, USA
  • Shruti Jesani Department of Internal Medicine, Rutgers NJMS/Trinitas Regional Medical Center, Elizabeth, NJ, USA
  • Carlos Perez Hernandez Department of Internal Medicine, Rutgers NJMS/Trinitas Regional Medical Center, Elizabeth, NJ, USA
  • Hardik Fichadiya Department of Internal Medicine, Rutgers NJMS/Trinitas Regional Medical Center, Elizabeth, NJ, USA
  • Muhammad Atif Masood Noori Department of Internal Medicine, Rutgers NJMS/Trinitas Regional Medical Center, Elizabeth, NJ, USA
  • Omar Elkattawy Department of Internal Medicine, Rutgers NJMS, Elizabeth, NJ, USA
  • Edward Williams Department of Cardiology, Trinitas Regional Medical Center, Elizabeth, NJ, USA

Keywords

Left ventricular thrombus, ventricular fibrillation, ventricular tachycardia, electrical storm

Abstract

Left ventricular thrombus (LVT) formation is a serious clinical complication of low-flow states that may be seen in an ischaemic, arrhythmic heart. While LVT formation has a poor prognosis, in the setting of myocardial infarction it is usually a result of post-infarct sequelae such as left ventricle aneurysms, and inflammatory changes from damaged tissue, with the LVT taking several days to form. Arrythmias such as ventricular tachycardia (VT) or ventricular fibrillation (VF) may also lead to thrombus formation, as they contribute to stasis due to decreased cardiac output. Large anterolateral myocardial infarctions can cause electrical or arrhythmic storm, characterized by more than three episodes of VT or VF in a 24-hour period. This prolonged state of dyskinesis further increases the risk of thrombosis, creating a compounding effect. Here, we report the case of a patient who had a VF cardiac arrest with electrical storm secondary to anterolateral myocardial infarction complicated with LVT formation found on echocardiogram after the cardiac arrest, which was absent on presentation. This thrombus formation occurred particularly early during the course of the patient’s arrest, possibly due to the compounding factors increasing the risk of thrombosis. Herein, we discuss in detail the risk factors for LVT formation, its mechanism and management options. A review of the literature also shows that LVT formation in the acute phase of arrest, as seen in our patient, is rare.

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References

  • Eifling M, Razavi M, Massumi A. The evaluation and management of electrical storm. Tex Heart Inst J 2011;38(2):111–121.
  • Nademanee K, Taylor R, Bailey WE, Rieders DE, Kosar EM. Treating electrical storm: sympathetic blockade versus advanced cardiac life support-guided therapy. Circulation 2000 Aug 15;102(7):742–747. doi: 10.1161/01.cir.102.7.742. PMID: 10942741.
  • Delewi R, Zijlstra F, Piek JJ. Left ventricular thrombus formation after acute myocardial infarction. Heart 2012;98:1743–1749.
  • Küpper AJ, Verheugt FW, Peels CH, Galema TW, Roos JP. Left ventricular thrombus incidence and behavior studied by serial two-dimensional echocardiography in acute anterior myocardial infarction: left ventricular wall motion, systemic embolism and oral anticoagulation. J Am Coll Cardiol 1989;13(7):1514–1520. doi: 10.1016/0735-1097(89)90341-0.
  • de Gregorio C, Stanzione A. Cardiac thrombus formation during cardiopulmonary resuscitation for cardiac arrest: is it time for ultrasound-enhanced algorithms? J Cardiovasc Echogr 2019;29(4):169–171. doi: 10.4103/jcecho.jcecho_16_19.
  • Budhram GR, Mader TJ, Lutfy L, Murman D, Almulhim A. Left ventricular thrombus development during ventricular fibrillation and resolution during resuscitation in a swine model of sudden cardiac arrest. Resuscitation 2014 May;85(5):689–693. doi: 10.1016/j.resuscitation.2014.01.030.
  • Wada T. Coagulofibrinolytic changes in patients with post-cardiac arrest syndrome. Front Med (Lausanne) 2017;4:156. doi: 10.3389/fmed.2017.00156.
  • Albaeni A, Chatila K, Beydoun HA, Beydoun MA, Morsy M, Khalife WI. In-hospital left ventricular thrombus following ST-elevation myocardial infarction. Int J Cardiol 2020 Jan 15;299:1–6. doi: 10.1016/j.ijcard.2019.07.070. PMID: 31371119; PMCID: PMC6891157.
  • Oh JK, Park JH, Lee JH, Kim J, Seong IW. Shape and mobility of a left ventricular thrombus are predictors of thrombus resolution. Korean Circ J 2019;49(9):829–837. doi: 10.4070/kcj.2018.0346.
  • Chinitz JS, Mendoza DD, Kim RJ, Weinsaft JW. Cardiac imaging for assessment of left ventricular thrombus. US Cardiol Rev 2009;6(2):27–33.
  • Iqbal H, Straw S, Craven TP, Stirling K, Wheatcroft SB, Witte KK. Direct oral anticoagulants compared to vitamin K antagonist for the management of left ventricular thrombus. ESC Heart Fail 2020;7(5):2032–2041. doi: 10.1002/ehf2.12718.
  • Dalia T, Lahan S, Ranka S, Goyal A, Zoubek S, Gupta K. Warfarin versus direct oral anticoagulants for treating left ventricular thrombus: a systematic review and meta-analysis. Thrombosis J 2021;19(1):7.
  • Lattuca B, Bouziri N, Kerneis M, Portal JJ, Zhou J, Hauguel-Moreau M, et al.; ACTION Study Group. Antithrombotic therapy for patients with left ventricular mural thrombus. J Am Coll Cardiol 2020 Apr 14;75(14):1676–1685. doi: 10.1016/j.jacc.2020.01.057. PMID: 32273033.
  • Kikuchi S, Hibi K, Tamura K, Kimura K. Free-floating left ventricular thrombus after rapid improvement of cardiac function related to mechanical hemodynamic support. J Cardiol Cases 2020 Mar 18;21(6):231–233. doi: 10.1016/j.jccase.2020.02.009. PMID: 32547660; PMCID: PMC7283294.
  • Published: 2022-06-23

    Issue: 2022: Vol 9 No 6 (view)

    Section: Articles

    How to cite:
    1.
    Alyacoub R, ElKattawy S, Jesani S, Hernandez CP, Fichadiya H, Noori MAM, Elkattawy O, Williams E. Early Left Ventricular Thrombus Following Ventricular Fibrillation/Ventricular Tachycardia Electrical Storm. EJCRIM 2022;9 doi:10.12890/2022_003327.

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