Differentiating LAA Thrombus From Spontaneous Echo Contrast for Safe LAA Occlusion

Left atrial appendage (LAA) occlusion is a valuable therapeutic option for stroke prevention in patients with atrial fibrillation who have contraindication to long-term anticoagulation. However, the presence of LAA thrombus is a contraindication to device implantation. Differentiating a true thrombus from spontaneous echo contrast or "sludge" on transesophageal echocardiography is both challenging and crucial for procedural safety. We present a series of cases using adjunctive modalities that allowed safe LAA occluder deployment.