Background: Little is known about the prevalence of ATRIAL THROMBOSIS in ATRIAL flutter undergoing cardioversion of rhythm. Several studies, however, have shown that patients with ATRIAL fibrillation have a high prevalence of ATRIAL THROMBOSIS, strongly associated with increased risk of embolism in ATRIAL fibrillation. Still, the incidence of ATRIAL thrombi in patients with ATRIAL flutter is not well established.Methods: Transesophageal echocardiography was done in 30 consecutive non-anticoagulated patients with a mean age of 48.4 years who were admitted for cardioversion of ATRIAL flutter. Mean left ATRIAL size was 4.3cm and mean ejection fraction was 42%. The mean duration of flutter was more than 48 hours. Left ATRIAL thrombus was seen in 2 patients.Results: Two patients had left ATRIAL THROMBOSIS and both of them had rheumatic mitral stenosis. The other patients were free of THROMBOSIS.Conclusion: This study suggests that ATRIAL thrombus is uncommon in patients with ATRIAL flutter, and there is a low risk of thromboembolism after cardioversion, except in rheumatic mitral stenosis, which itself has a high prevalence of left ATRIAL THROMBOSIS.

Background: The systemic immune-inflammation index (SII) has recently been investigated for cardiovascular diseases. We aimed to evaluate the relationship between SII and left ATRIAL THROMBOSIS (LAT). Methods: This retrospective, case-control study recruited patients with nonvalvular ATRIAL fibrillation (NVAF) who underwent transesophageal echocardiography (TEE) for LAT detection before cardioversion or catheter ablation at a tertiary hospital between 2012 and 2021. Demographic characteristics were obtained from the hospital data system. According to TEE findings, the patients were categorized into LAT (+) and (-) groups. Age, gender, history of chronic diseases, urea, creatinine, albumin, hemogram parameters, the neutrophil-lymphocyte ratio (NLR), the platelet-lymphocyte ratio (PLR), SII, the CHADS₂,score, the CHA₂, DS₂,-VASc score, echocardiographic parameters, antiaggregant-anticoagulant use, and nonparoxysmal ATRIAL fibrillation were included and analyzed. Results: The study population consisted of 403 patients, including 228 men (56. 6%), at a mean age of 60. 84±, 12. 26 years. A high white blood cell count (WBC) (OR, 1. 26,95% CI, 1. 05 to 1. 51,P=0. 013), a high SII (OR, 1. 00, 95% CI, 1. 00 to 1. 00,P=0. 003), and a low ejection fraction (OR, 0. 95,95% CI, 0. 90 to 0. 99,P=0. 018) were independent predictors of LAT (+). A spontaneous echo contrast (OR, 2. 43,95% CI, 1. 35 to 4. 39,P=0. 003) was associated with LAT (+). SII values above 693. 6 predicted LAT (+) with 71. 6% sensitivity and 71. 7% specificity (AUC, 0. 77,P<0. 001). The predictiveness of SII was similar to that of NLR (0. 77 vs 0. 74, P=0. 093) but higher than PLR (0. 77 vs 0. 67,P<0. 001) and WBC (0. 77 vs 0. 69,P=0. 031). Conclusion: SII is an independent predictor of LAT in patients with NVAF.

Background: Acute lymphoblastic leukemia (ALL) is the most common malignancy diagnosed in children.Extra medullary leukemia including hepatosplenomegaly, lymphadenopathy, and mediastinal mass are the clinical presentations of T-cell ALL. Pericardial effusion and ATRIAL mass are rare presentations of pediatric leukemia.Case Presentation: We report a 15-year-old girl with T-cell ALL, who presented initially with pericardial effusion and cardiac tamponade and subsequently developed right ATRIAL mass. The mediastinal and right ATRIAL masses were excised by surgical procedure as a treatment strategy for prevention of arrhythmia and sudden death.Conclusion: T-cell ALL can present with pericardial and mediastinal involvement as an initial manifestation.Pericardiocenthesis and systemic anticancer chemotherapy without local chemotherapy should be considered in these cases.

THROMBOSIS is a rare complication of acute lymphoblastic leukemia usually occurring following chemotherapy. The most common reported site is intracranial THROMBOSIS. We reported a case of acute lymphoblastic leukemia with right ATRIAL THROMBOSIS and pulmonary embolism at diagnosis. This diagnosis is important as it can greatly contribute to morbidity and mortality in acute lymphoblastic leukemia patients.

Apixaban was introduced in clinical use for nonvalvular ATRIAL fibrillation as an alternative to warfarin. There is a dearth of information regarding apixaban use in patients suffering from ATRIAL fibrillation with intracardiac foreign bodies such as pacemaker leads. In this report, we describe a 72-year-old female patient with a complaint of weakness in both legs of a few days’ duration. She was detected to have a thrombus over the pacemaker lead and inside the left ATRIAL appendage during apixaban treatment. After the discontinuation of apixaban and the commencement of warfarin, the thrombus was resolved. Our case is the first report to show that apixaban treatment (5 mg, twice daily) may not prevent the development of pacemaker lead THROMBOSIS in patients with ATRIAL fibrillation.

A 72-year-old patient with a history of nonobstructive hypertrophic cardiomyopathy type III and ATRIAL fibrillation of several years’ duration presented to the emergency department with dyspnea at rest (New York Heart Association functional class IV). The patient had been using metoprolol, digoxin, furosemide, and warfarin and had a history of significant variations in the International Normalized Ratio (INR). Physical examinations revealed irregular pulse (80 bpm), pulmonary fine rales in the half lower part of both lungs, and lower extremity edema (2+).