LAA thrombi are associated with spontaneous echocardiographic contrast (Figs. 3B and 7; please see companion DVD for corresponding video for Fig. 3) and more depressed (<0.2 m/s) LAA ejection velocities (Fig. 8 [please see companion DVD for corresponding video], compare to Fig. 5). Although less than 10% of thrombi are seen in the right atrial appendage, this area is nearly impossible to see from TTE approaches, but well investigated by TEE (Fig. 9). Thus, TEE offers the opportunity to exclude atrial thrombi, and therefore facilitate early and safe cardioversion. The strategy we have advocated (Fig. 10) is for the patient to be thera-peutically anticoagulated with unfractionated heparin (partial thromboplastin time >2X control) or warfarin (INR > 2.0) at the time of TEE and extending for at least 1 mo after cardioversion. The use of systemic
Spontaneous LA Echocontrast *
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