Clinical Report: Bilateral Thrombosis of Atrial Appendages in AL-CA

Background

Light chain cardiac amyloidosis (AL-CA) is characterized by the deposition of misfolded monoclonal immunoglobulin light chains in the myocardium, leading to significant cardiac dysfunction. It is associated with a poor prognosis, often presenting with diastolic heart failure and arrhythmias.

Data Highlights

No numerical data or trial data provided in the article.

Key Findings

• The patient presented with progressive exertional dyspnea and recurrent syncope.
• Cardiac imaging revealed biatrial enlargement and intracardiac thrombi in both atrial appendages.
• Laboratory tests showed markedly elevated NT-proBNP levels and monoclonal lambda light chains.
• A permanent VVI pacemaker was implanted due to recurrent syncope associated with prolonged RR intervals.
• Anticoagulation therapy with rivaroxaban was initiated after detection of thrombi.

Clinical Implications

This case underscores the importance of monitoring for thrombus formation in patients with light chain cardiac amyloidosis, particularly those with atrial flutter. Anticoagulation may be necessary to mitigate thromboembolic risks in this high-risk population.

Conclusion

Bilateral atrial appendage thrombosis in light chain cardiac amyloidosis presents significant clinical challenges and highlights the need for vigilant assessment and management of thromboembolic risks.

Related Resources & Content

1. Frontiers in Cardiovascular Medicine, 2026 -- Right atrial appendage thrombosis after percutaneous left atrial appendage occlusion: a case report
2. Clinical Research in Cardiology, 2016 -- Rare instance of cardiac ATTR amyloidosis associated with situs inversus totalis
3. the asco post, 2025 -- Updates in Systemic Light-Chain Amyloidosis
4. 2024 ESC Guidelines for Management of Atrial Fibrillation: Key Points - American College of Cardiology
5. Frontiers in Immunology — Biomolecular mechanisms of cardiac amyloidosis and its cardiovascular pathological basis
6. 2024 ESC Guidelines for Management of Atrial Fibrillation: Key Points - American College of Cardiology
7. https://article.imrpress.com/journal/RCM/26/3/10.31083/RCM26948/bc50daa5c445da166297ea25c01b7a24.pdf
8. American Society of Hematology (ASH) 2026 Guidelines on Diagnosis of Light Chain Amyloidosis - PubMed