Massive Atrial Thrombosis: A Serious Complication of the Maze Procedure Triggered by Heparin-Induced Thrombocytopenia (HIT)

Atrial fibrillation is one of the most common cardiac arrhythmias, classically presenting with an “irregularly irregular” rhythm with or without chest pain, palpitations, shortness of breath, lightheadedness, or fatigue. The maze procedure is an open-heart operation that creates a carefully designed maze of incisions and ablations in the atrial myocardium. Although it is a common procedure, serious complications may happen. Herein, we report on a 76-year-old man who presented with chest pain and atrial fibrillation and was found to have multi-vessel disease on a coronary angiogram. He underwent coronary artery bypass and the COX-maze procedure, which was complicated by a massive thrombosis in the atria and the superior vena cava following the ablation line, secondary to heparin-induced thrombocytopenia, which is extremely rare. The central focus of this paper is to present this rare complication to stress the importance of rigorous follow-up and anticoagulation therapy in patients undergoing the maze procedure. To our knowledge, we are the first to report such a rare case of diffuse large atrial thrombi triggered by heparin-induced thrombocytopenia (HIT) type II after a COX-maze procedure.