Afyon Kocatepe University, Turkey
Ersel Onrat, MD, male, he was born in Turkey 1970, married and has one child. He graduated from School of Medicine, Hacettepe University in 1993 and attended the Osmangazi University, School of Medicine, Cardiology Department and graduated as a cardiologist in 1998. In 1999 he founded Cardiology Department in School of Medicine in Afyon Kocatepe University. He is a Professor since 2012 and also the chief of the Cardiology Department, chief of the Coronary Catheterization Labratory in School of Medicine in Afyon Kocatepe University, a lecturer in the same faculty as well.. Dr. Professor Ersel is interested in interventional cardiology and has some projects about atrial fibrillation, idiopathic dilated cardiomyopathy and cardiac rehabilitation. He has 44 scientific cardiology article in international cardiology journal.
Seventy four years old, caucassian female patient brought in to emergency department for an acute onset and deteriorating dyspnea. A DDD-R pacemaker was implanted seven years ago because of complete AV block. Previous routine follow-up exams and pacemaker technical values were within normal limits in all 7 years. But she was in atrial fibrillation in last follow up which was one month ago before detecting thrombus in pacemaker lead. Transtorasic echocardiography revealed a 1.5 x3.0 cm trombus in the right atrium attached to the lead (Figure 1). Patient was admitted to cardiovasular surgery intensive care unit with a plan for surgery because of large thrombus. Electrode-associated right atrial (RA) thrombus appears to be relatively common in acute period after pacemaker implantation and It’s usually asymptomatic. Patient’s previous follow-ups were within normal limits in 7 years. Probably an electrode-associated RA thrombi in this case has been happened after atrial fibrillation started and she has been taking no anticoagulan medicine. The important point which makes this case novel is there wasn’t thrombus formation before the patient was in AF in 7 years . According to best of our knowledge, there is no preivous case presented as atrial fibrillation associated pace maker lead thrombus in late period after lead implantation. It’s important to initiate anticoagulation as soon as the AF is detected, in patients with pacemakers. It is important that thrombus can occur in right chambers of heart beacuse of pacemaker electrodes.