Usefulness of the intracardiac electrocardiogram recorded using central venous catheters on P-wave magnification.

BACKGROUND: The detection of atrial electrical activity is extremely valuable in recognizing complex cardiac arrhythmias. However, P-wave detection on a surface electrocardiogram (S-ECG) can sometimes be challenging. The intracardiac electrocardiogram (IC-ECG), recorded by a central venous catheter loaded with saline solution, has proven to be a safe and effective method for amplifying atrial electrical activity. We aim to compare the P-wave amplitude recorded in the S-ECG and the IC-ECG in different venous accesses, catheters, heart rhythms, and atrial dimensions. METHODS: We compared the P wave amplitude obtained by the IC-ECG and the S-ECG recordings from cardiac intensive care unit patients. RESULTS: In 109 nonconsecutive patients, a total of 166 IC-ECG were collected. The median amplitude of the P wave was 0.1 (0.083-0.3) mV in the S-ECG and 0.4 (0.25-2.4) mV in the IC-ECG; p < 0.001. This difference remained significant regardless of the patient's heart rhythm, left atrial dimension, and catheter or vascular access used. CONCLUSION: The IC-ECG acquired using central venous catheters significantly increases atrial electrical activity signals. This technique might help identify complex cardiac arrhythmias.

Comportamiento del tiempo de conducción retrógrada al momento de la inducción de las taquicardias supraventriculares y su rol en el diagnóstico diferencial / Behavior of Retrograde Conduction Time at Supraventricular Tachycardia Induction and its Role in Differential Diagnosis

RESUMEN Antecedentes : El diagnóstico diferencial entre la taquicardia reentrante ortodrómica (TRO) y la taquicardia por reentrada nodal atípica (TRNa) puede ser dificultoso. Nuestra hipótesis es que las TRNa tienen más variabilidad en el tiempo de con ducción retrógrada al comienzo de la taquicardia que las TRO. Nuestros objetivos fueron evaluar la variabilidad en el tiempo de conducción retrógrada al inicio de la taquicardia en TRNa y TRO, y proponer una nueva herramienta diagnóstica para diferenciar estas dos arritmias. Métodos : Se midió el intervalo ventrículo-auricular (VA) de los primeros latidos tras la inducción de la taquicardia, hasta su estabilización. La diferencia entre el intervalo VA máximo y el mínimo se definió como delta VA (ΔVA). También contamos el número de latidos necesarios para que se estabilice el intervalo VA. Se excluyeron las taquicardias auriculares. Resultados : Se incluyeron 101 pacientes. Se diagnosticó TRO en 64 pacientes y TRNa en 37. El ΔVA fue 0 (rango intercuartílico, RIC, 0-5) milisegundos (ms) en la TRO frente a 40 (21-55) ms en la TRNa (p < 0,001). El intervalo VA se estabilizó significativamente antes en la TRO (1,5 [1-3] latidos) que en la TRNa (5 [4-7] latidos; p < 0,001). Un ΔVA < 10 ms diagnosticó TRO con 100% de sensibilidad, especificidad y valores predictivos positivo y negativo. La estabilización del intervalo VA en menos de 3 latidos predijo TRO con buena precisión diagnóstica. Los resultados fueron similares considerando sólo vías accesorias septales. Las TRN típicas tuvieron una variación intermedia. Conclusión : Un ΔVA < 10 ms es un criterio simple, que distingue con precisión la TRO de la TRNa, independientemente de la localización de la vía accesoria.

ABSTRACT Background : Differential diagnosis between orthodromic reentrant tachycardia (ORT) and atypical nodal reentrant tachy cardia (ANRT) can be challenging. Our hypothesis was that ANRT presents more variability in retrograde conduction time at tachycardia onset than ORT. Objectives : The objectives of this study were to assess retrograde conduction time variability at the start of tachycardia in ANRT and ORT, and postulate a new diagnostic tool to differentiate these two types of arrhythmias. Methods : The ventriculoatrial (VA) interval of the first beats after tachycardia induction was measured until stabilization. The difference between the maximum and minimum VA interval was defined as delta VA (ΔVA), and the number of beats needed for VA interval stabilization was also assessed. Atrial tachycardias were excluded. Results : In a total of 101 patients included in the study, ORT was diagnosed in 64 patients and ANRT in 37. ΔVA interval was 0 (interquartile range [IQR] 0-5) milliseconds (ms) in ORT vs. 40 (21-55) ms in ANRT (p <0.001). The VA interval significantly stabilized earlier in ORT (1.5 [1-3] beats) than in ANRT (5 [4-7] beats) (p<0.001). A ΔVA <10 ms diagnosed ORT with 100% sensitivity, specificity, and positive and negative predictive values. Ventriculoatrial interval stabilization in less than 3 beats predicted ORT with good diagnostic accuracy. The results were similar considering only accessory septal pathways. Typical NRTs presented an intermediate variation. Conclusion : Presence of DVA <10 ms is a simple criterion that accurately differentiates ORT from ANRT, independently of the accessory pathway localization.

Variability of the VA interval at tachycardia induction: a simple method to differentiate orthodromic reciprocating tachycardia from atypical atrioventricular nodal reentrant tachycardia.

BACKGROUND: The differential diagnosis between orthodromic atrioventricular reentry tachycardia (AVRT) and atypical AV nodal reentrant tachycardia (aAVNRT) is sometimes challenging. We hypothesize that aAVNRTs have more variability in the retrograde conduction time at tachycardia onset than AVRTs. METHODS: We aimed to assess the variability in retrograde conduction time at tachycardia onset in AVRT and aAVNRT and to propose a new diagnostic tool to differentiate these two arrhythmia mechanisms. We measured the VA interval of the first beats after tachycardia induction until it stabilized. The difference between the maximum and minimum VA intervals (∆VA) and the number of beats needed for the VA interval to stabilize was analyzed. Atrial tachycardias were excluded. RESULTS: A total of 107 patients with aAVNRT (n = 37) or AVRT (n = 64) were included. Six additional patients with decremental accessory pathway-mediated tachycardia (DAPT) were analyzed separately. All aAVNRTs had VA interval variability. The median ∆VA was 0 (0 - 5) ms in AVRTs vs 40 (21 - 55) ms in aAVNRTs (p < 0.001). The VA interval stabilized significantly earlier in AVRTs (median 1.5 [1 - 3] beats) than in aAVNRTs (5 [4 - 7] beats; p < 0.001). A ∆VA < 10 ms accurately differentiated AVRT from aAVNRT with 100% of sensitivity, specificity, and positive and negative predictive values. The stabilization of the VA interval at < 3 beats of the tachycardia onset identified AVRT with sensitivity, specificity, and positive and negative predictive values of 64.1%, 94.6%, 95.3%, and 60.3%, respectively. A ∆VA < 20 ms yielded good diagnostic accuracy for DAPT. CONCLUSIONS: A ∆VA < 10 ms is a simple and useful criterion that accurately distinguished AVRT from atypical AVNRT. Central panel: Scatter plot showing individual values of ∆VA in atypical AVNRT and AVRT. Left panel: induction of atypical AVNRT. The VA interval stabilizes at the 5th beat and the ∆VA is 62 ms (maximum VA interval: 172 ms - minimum VA interval: 110 ms). Right panel: induction of AVRT. The tachycardia has a fixed VA interval from the first beat. ∆VA is 0 ms.

Value of Electrocardiography to Distinguish Fabry Disease from Sarcomeric Hypertrophic Cardiomyopathy.

Fabry disease (FD) is a rare genetic disorder that leads to left ventricular hypertrophy (LVH), frequently misdiagnosed as hypertrophic cardiomyopathy (HCM). We sought to assess the value of electrocardiography for distinguishing FD from HCM. We retrospectively reviewed and compared standard electrocardiograms and echocardiograms from 26 patients with FD and LVH and 33 sarcomeric patients with HCM, matched for gender, age, and degree of LVH. The mean age of patients with FD was 46 years (interquartile range) (28 to 53) and of HCM 50 (30 to 61) years (p = 0.27). Of them, 16 (61%) and 25 (76%) were male, respectively (p = 0.26). Indexed left ventricular mass was 166 g/m2 in FD versus 181 g/m2 in HCM (p = 0.88). All patients with FD and 30 (91%) with HCM were in sinus rhythm (p = 0.25). A higher prevalence of right bundle branch block (RBBB) was observed in FD (27%) versus HCM (6%) (p = 0.03). The PR interval was shorter in FD, 140 ms (120-160) versus 160 ms (140 to 180) (p = 0.004). P-wave duration was longer in patients with FD, 100 ms (80 to 120) versus 80 ms (80 to 100) (p = 0.01). The PQ interval (PR interval minus P-wave duration) was shorter in patients with FD, 40 ms (20 to 45) versus 80 ms (40 to 80) (p = 0.001). There were no differences regarding P-wave amplitude, QRS complex duration, corrected QT length, conduction or repolarization abnormalities, Sokolow-Lyon index, and Cornell index. After multivariate adjustments for RBBB, PR interval, P-wave duration, and PQ interval, a PQ interval ≤40 ms and RBBB were significantly associated with FD. In conclusion, there are electrocardiogram characteristics, such as the presence of RBBB or a PQ interval ≤40 ms, that may be helpful for screening and reducing the delay in FD diagnosis.

[Cardiac metastasis from primary anaplastic thyroid carcinoma]. / Metástasis cardíaca de carcinoma anaplásico de tiroides.

Cardiac neoplasms are rare entities in the clinical practice. Cardiac metastatic involvement is 20 to 40 times more frequent than the primary form, representing 95% of all cardiac tumors; however, they are frequently underdiagnosed because of their clinical and oncologic features. In this report, we present two cases of cardiac metastasis from primary anaplastic thyroid carcinoma: a 69-years-old woman with right ventricular metastasis and a 61-years-old man with right atrial metastasis. Both patients died during their hospitalization and one of them underwent an autopsy.

Las neoplasias cardíacas son entidades poco frecuentes en la práctica clínica cardiológica y dentro de éstas, la afectación metastásica es 20 a 40 veces más frecuente que la forma primaria, correspondiendo al 95% de todos los tumores cardíacos; no obstante, debido a las características clínicas y oncológicas del tumor primario, los tumores cardíacos metastásicos son habitualmente subdiagnosticados. En este trabajo se presentan dos casos de pacientes con carcinoma anaplásico de tiroides, una mujer de 69 años con metástasis en ventrículo derecho y un varón de 61 años con metástasis en aurícula derecha. Ambos pacientes fallecieron durante la internación y a uno de ellos se le realizó autopsia.

Metástasis cardíaca de carcinoma anaplásico de tiroides / Cardiac metastasis from primary anaplastic thyroid carcinoma

Resumen Las neoplasias cardíacas son entidades poco frecuentes en la práctica clínica cardiológica y dentro de éstas, la afectación metastásica es 20 a 40 veces más frecuente que la forma primaria, corres pondiendo al 95% de todos los tumores cardíacos; no obstante, debido a las características clínicas y oncológicas del tumor primario, los tumores cardíacos metastásicos son habitualmente subdiagnosticados. En este trabajo se presentan dos casos de pacientes con carcinoma anaplásico de tiroides, una mujer de 69 años con metástasis en ventrículo derecho y un varón de 61 años con metástasis en aurícula derecha. Ambos pacientes fallecieron durante la internación y a uno de ellos se le realizó autopsia.

Abstract Cardiac neoplasms are rare entities in the clinical practice. Cardiac metastatic involvement is 20 to 40 times more frequent than the primary form, representing 95% of all cardiac tumors; however, they are frequently underdiagnosed because of their clinical and oncologic features. In this report, we present two cases of cardiac metastasis from primary anaplastic thyroid carcinoma: a 69-years-old woman with right ventricular metastasis and a 61-years-old man with right atrial metastasis. Both patients died during their hospitalization and one of them underwent an autopsy.

Catheter ablation of ventricular tachycardia in patients with electrical storm, with a special focus on patients with Chagas disease.

BACKGROUND: There are few reports on the benefits of catheter ablation (CA) in patients with electrical storm (ES). None of these publications included patients with Chagas disease (ChD). Our aims are to analyze (1) all the cases of ES treated with CA and (2) the subgroup of patients with ChD. METHODS: Prospective analysis of consecutive patients with ES due to monomorphic ventricular tachycardia (VT) treated with CA. RESULTS: We included 38 patients: 28 males; median age of 63.5 (IQR 55-71) years old; ejection fraction (LVEF) 0.30 (0.25-0.40). Sixteen patients (42.1%) had ChD. The patients experienced 21 (15-37) VT episodes and received 7 (3-13) ICD shocks before CA. Forty-six procedures were performed (7 required epicardial access). All patients experienced ES suppression after CA. After 35 (10-64) months of follow-up (1.21 procedures per patient), 23 patients (60.5%) remain free from any VT; 35 patients (92.1%) were free from ES, and 11 patients (28.9%) died from non-arrhythmic causes. One patient underwent heart transplantation. Patients with ChD were younger (60 vs. 67 years old; p = 0.033), significantly more women (50% vs. 9.1%; p = 0.005), and had higher LVEF (0.40 vs. 0.28; p < 0.001) than the other patients. Long-term outcome of ChD patients was similar to that of the overall population. Only age and LVEF independently predicted mortality. CONCLUSION: CA was associated with acute ventricular arrhythmia suppression in all patients with ES. Freedom rates from ES and VT were 92.1% and 60.5% respectively. Despite having a lower-risk clinical profile, patients with ChD had a comparable outcome to that of the other patients.

Resultados del primer registro de implante de cardiodesfibriladores y resincronizadores SAC (RENCARE) / Results of the First SAC Implantable Cardioverter-Defibrillator and Cardiac Resynchronization Therapy Registry (RENCARE)

RESUMEN Introducción: La prevención de la muerte súbita y el tratamiento de la insuficiencia cardíaca son temas de gran importancia. Para prevenir la muerte súbita y mejorar el pronóstico de la insuficiencia cardíaca se utilizan los cardiodesfibriladores y cardioresincronizadores. Objetivos: Evaluar la cantidad y tipo de dispositivos implantados en nuestro país, así como las características de los pacientes, las complicaciones agudas y las que se presentan en el seguimiento. Material y métodos: Se realizó un estudio observacional, prospectivo, multicéntrico en centros de salud con la capacidad de implantar cardiodesfibriladores y cardioresincronizadores. Se incluyeron pacientes a los que se les realizó implante de estos dispositivos desde enero del 2016 hasta enero de 2017, con un seguimiento de 12 meses. Resultados: Se incluyeron 249 pacientes (edad promedio de 64,8 ± 13,7 años, 73,9% de sexo masculino, 72,1% con Fey < 35%). La etiología subyacente de la miocardiopatía era isquémica en el 39,8%, dilatada 26,7% y chagásica en el 11,2% de los casos. El 58% de los implantes realizados fueron cardiodesfibriladores y el 39%, cardiodesfibriladores asociados con cardioresincronizadores. El 84% de los procedimientos fueron primoimplantes. La indicación más frecuente del implante fue por prevención primaria de muerte súbita (67,9%). La tasa de complicaciones menores fue del 4,4% y no se reportaron complicaciones mayores. Conclusiones: El siguiente registro evidenció una gran proporción de implantes en pacientes con cardiopatía isquémica, la indicación principal fue por prevención primaria de muerte súbita y la tasa de complicaciones fue similar a la reportada internacionalmente.

ABSTRACT Background: Prevention of sudden death and treatment of heart failure are very important topics. Implantable cardioverter-defibrillator and cardiac resynchronization devices are used to prevent sudden death and improve heart failure symptoms and prognosis. Objectives: The aim of this study was to evaluate the number, type of implanted devices, clinical characteristics of the patients and acute and follow-up complications. Methods: An observational, prospective, multicenter study was carried out in healthcare centers with the capacity to implant cardioverter-defibrillator and cardiac resynchronization devices. The study included all patients who underwent implantation of these devices from January 2016 to January 2017, with a 12-month follow-up. Results: A total of 249 patients (73.9% men) with mean age of 64.8±13.7 years, and 72.1% with ejection fraction <35%, were included in the study. The underlying cardiomyopathy etiology was ischemic in 39.8% of cases, dilated in 26.7% and chagasic in 11.2%. Fifty-eight percent of implants were implantable cardioverter-defibrillators and 39% were cardioverter-defibrillators associated with cardiac resynchronization devices. In 84% of cases, procedures were first implants. The most frequent indica-tion of implantation was for primary prevention of sudden death (67.9%). Minor complication rate was 4.4% and no major complications were reported. Conclusions: The present registry evidenced a large proportion of cardioverter-defibrillator and cardiac resynchronization implants in patients with ischemic heart disease. The main indication was for primary prevention of sudden death and the complication rate was similar to that reported internationally.

Utilidad de un sistema de registro de una derivación electrocardiográfica y transmisión inalámbrica durante la pandemia por COVID-19 / Electrocardiographic Recording System and Wireless Transmission During the COVID-19 Pandemic

RESUMEN Introducción: Se ha comunicado que algunos tratamientos utilizados para la infección por COVID-19 pueden ocasionar alteraciones del intervalo QT y arritmias graves. La medición por electrocardiograma (ECG) convencional requiere personal adicional y riesgo de contagio. Nuevas tecnologías para obtención de un ECG conectados a teléfonos inteligentes (smartphones) proporcionan una alternativa para evaluación del QTc. Objetivo: El objetivo fue evaluar la factibilidad de un dispositivo para registro electrocardiográfico de un canal, para la medición del intervalo QT en pacientes con sospecha o confirmación de infección por COVID-19, antes de recibir drogas que prolongan el intervalo QT. Material y métodos: Se obtuvieron registros de ECG con un dispositivo Kardia Mobile (KM) con trasmisión a un smarthphone. La sección de electrofisiología cardíaca centralizó la recepción por medio electrónico de los ECG en formato de archivo pdf y realizó las mediciones de los intervalos QTm y QTc. Resultados: Se estudiaron 31 pacientes, edad promedio 61 años (rango 20-95 años), sospechosos de presentar infección por COVID-19 enrolados para tratamiento con hidroxicloroquina, azitromicina, ritonavir y lopinavir. Los registros pudieron ser leídos en todos los casos, y debieron repetirse en dos casos. Los valores del intervalo QTc promedio en varones y mujeres fue 423 mseg (rango 380-457 mseg) y 439 mseg (rango 391-540 mseg), respectivamente. El tiempo de respuesta desde el envío del ECG al grupo de análisis fue 11 min (rango 1-155). Conclusiones: Los registros ECG obtenidos con dispositivos KM, para trasmisión a un smartphone a un grupo central de lectura, permitieron la medición del intervalo QTc en todos los pacientes.

ABSTRACT Background: Some therapies used for COVID-19 can prolong the QT interval and produce severe arrhythmias. QT interval measured from a standard electrocardiogram (ECG) requires additional personnel and risk of infection. Novel technologies to obtain an ECG connected to smartphones provide an alternative for the evaluation of corrected QT interval (QTc). Objective: The aim of this study was to evaluate the feasibility of using a single-lead ECG device to measure the QT interval in patients with suspected or confirmed COVID-19 before receiving treatment with drugs that can prolong the QT interval. Methods: The ECG was obtained with a KardiaMobile (KM) device and transmitted to a smartphone. The ECG recordings were saved as pdf files and electronically submitted to the electrophysiology section which centralized the reception and assessed the measured QT and QTc intervals. Results: A total of 31 patients (mean age 61 years, range 20-95 years) with suspected COVID-19 enrolled for treatment with hydroxychloroquine, azithromycin, ritonavir or lopinavir were analyzed. The recordings could be read in all the cases and had to be repeated in two cases. The mean value of the QTc interval was 423 ms (range 380-457 ms) in men and 439 ms (range 391-540 ms) in women. The response time since the ECG recording was submitted for analysis was 11 min (range 1-155). Conclusions: The QTc interval could be measured from ECG recordings obtained with KM devices connected to a smartphone and transmitted to a centralized reading center in all patients.

Patients' perceptions of argentine physicians' empathy based on the jefferson scale of patient's perceptions of physician empathy: Psychometric data and demographic differences.

BACKGROUND: The aim of this study was to evaluate the validity of a modified Spanish version of the Jefferson Scale of Patient's Perceptions of Physician Empathy (JSPPPE) in Argentine patients and to explore how local demographic characteristics influence patients' perceptions of their physicians' empathy. METHODS: A survey was conducted in March 2013 among 400 Spanish-speaking outpatients attending three different public or private hospitals of Buenos Aires. A principal component analysis (PCA) was used to identify the JSPPPE factor structure, and a confirmatory factor analysis (CFA) was employed to evaluate its construct validity. Demographic variables including age, gender, geographic origin, education, health coverage, regular physician-established and patient-perceived health status were used to find what factors may influence empathy rating. RESULTS: The PCA yielded a one-factor model that accounted for 77.5% of the variance, and an adequate model fit was observed with CFA indices. Male and elderly patients, South American descendants, less educated people, and public hospital attendants were associated with a higher JSPPPE score. Patients perceived a lower interest of physicians in their daily problems and a poorer capacity "to stand in their shoes." DISCUSSION: The JSPPPE provides a valid score to measure patients' perceptions of physician empathy in Argentina. These findings afford insight into Argentine patients' awareness of their doctors' empathic concern; however, JSPPPE scores may be alternatively interpreted in terms of patients' satisfaction or likeability.

Prospective validation of EuroSCORE II in patients undergoing cardiac surgery in Argentinean centres.

OBJECTIVES: The European System for Cardiac Operative Risk Evaluation II (EuroSCORE II) is an updated version of the original EuroSCORE that must be extensively validated. The objective was to prospectively evaluate the efficacy of EuroSCORE II in predicting the immediate results of cardiac surgery in Argentinean centres. METHODS: A prospective consecutive series of 503 adults who underwent cardiac surgery between January 2012 and April 2013 was studied. EuroSCORE II discrimination and accuracy were assessed in the overall cohort and in two surgically defined subgroups: isolated coronary artery bypass graft (CABG) surgery and non-CABG surgery. Additionally, a risk-adjusted cumulative sum control chart analysis was performed. RESULTS: In-hospital overall mortality rate was 4.17%, while the mortality rate predicted by the EuroSCORE II was 3.18% (P = 0.402). Receiver operating characteristic curve analysis demonstrated a good overall (area 0.856) and non-CABG subgroup (area 0.857) discrimination (P = 0.0001), while discrimination in the CABG subgroup was poorer (area 0.794, P = 0.014). The model showed good calibration in predicting in-hospital mortality, both overall (Hosmer-Lemeshow, P = 0.082) and for each subgroup (non-CABG, P = 0.308, and CABG, P = 0.150). CONCLUSIONS: EuroSCORE II reflects a better current surgical performance and offers a new quality standard to evaluate local outcomes. EuroSCORE showed an overall good discriminative capacity and calibration in this local population; nevertheless, the model performed optimally in non-CABG surgery and in highest-risk patients, underestimating in-hospital mortality in lowest-risk cases. The latter finding may be interpreted as an inadequate behaviour of the model, as a poor performance of surgeons or both. Larger prospective studies will elucidate this hypothesis.

Assessment of coronary flow with transthoracic color Doppler echocardiography in patients with hypertrophic cardiomyopathy.

BACKGROUND: Recent advances in echocardiography have allowed assessment of flow velocity in the epicardial coronary arteries of patients with ischemic heart disease, using transthoracic color Doppler echocardiography (TTDE). However, few data are available regarding coronary blood flow in patients with hypertrophic cardiomyopathy (HCM). OBJECTIVE: To assess the epicardial coronary arteries of patients with HCM. MATERIAL AND METHODS: A group of 25 patients with HCM was assessed prospectively (mean age 57 ± 21 years, 11 male) using TTDE; flow velocities in the epicardial coronary arteries were measured and compared with those obtained in 10 age- and gender-matched controls. Analysis of the diastolic spectral waveform included flow velocity integral (VTI), peak velocity, deceleration time, and deceleration slope measurements, while systolic waveform analysis included peak flow measurement and morphology assessment (positive, absent or negative). An analysis of variance (ANOVA) test was used for multiple comparisons for variables with a normal distribution, and a Kruskal-Wallis test was used for variables with non-Gaussian distribution. RESULTS: Patients with HCM exhibited an increase in diastolic flow velocity with a rapid deceleration slope and a systolic slope which was decreased, absent or reversed, compared to normal subjects. On linear regression analysis there was no correlation with the type of hypertrophy or magnitude of the intraventricular pressure gradient in patients with obstructive HCM. CONCLUSION: In patients with HCM, noninvasive assessment with TTDE revealed abnormal findings in the distal flow of the epicardial coronary arteries, very similar to those seen in the no-reflow phenomenon. These findings were independent of the type of hypertrophy and magnitude of the intraventricular pressure gradient in patients with obstructive HCM.

Right atrial thrombus mimicking myxoma with pulmonary embolism in a patient with systemic lupus erythematosus and secondary antiphospholipid syndrome.

Antiphospholipid syndrome is a well-defined entity that is characterized by spontaneous abortion, thrombocytopenia, and recurrent arterial and venous thromboses. A partially calcified right atrial thrombus mimicking myxoma with recurrent pulmonary embolism has not been previously reported in a patient who also had systemic lupus erythematosus and secondary antiphospholipid syndrome. Herein, we describe the case of a 37-year-old woman with systemic lupus erythematosus and secondary antiphospholipid syndrome who was admitted to the hospital with progressive exertional dyspnea. Ventilation-perfusion scanning showed multiple parenchymal defects in the lungs that portended pulmonary embolism. In addition, the scanning revealed normal regional ventilation. Transthoracic and transesophageal echocardiography showed a right atrial mass that was highly suggestive of myxoma, and the patient subsequently underwent surgery. A histologic examination showed an organized, partially calcified thrombus. Intracardiac thrombus has been rarely reported as a complication of antiphospholipid syndrome. In our patient, the preoperative investigations could not differentiate the partially calcified right atrial thrombus from a myxoma, and the diagnosis was made postoperatively.