{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T15:59:17Z","timestamp":1790697557327,"version":"4.1.0"},"reference-count":14,"publisher":"IMR Press","issue":"9","license":[{"start":{"date-parts":[[2026,9,4]],"date-time":"2026-09-04T00:00:00Z","timestamp":1788480000000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Clinical New Technology Incubation Project of Changhai Hospital","award":["2024XC108"],"award-info":[{"award-number":["2024XC108"]}],"id":[{"id":"https:\/\/ror.org\/02bjs0p66","id-type":"ROR","asserted-by":"crossref"}]},{"name":"Clinical New Technology Incubation Project of Naval Medical University","award":["ZXJS2024B15"],"award-info":[{"award-number":["ZXJS2024B15"]}]},{"name":"Medical \"Gaoling\" Discipline Construction Fund of Yangpu District","award":["25YPGL103"],"award-info":[{"award-number":["25YPGL103"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Rev. Cardiovasc. Med."],"abstract":"<jats:p>Background: Intracardiac echocardiography (ICE) is increasingly used for left atrial appendage (LAA) assessment during atrial fibrillation (AF) procedures. We describe a novel, thrombus-mimicking artifact on ICE, termed the \u201cFloating Lotus\u201d sign. Methods: In this retrospective multicenter study, we analyzed data from 172 patients undergoing ICE-guided AF ablation and\/or LAA occlusion. The incidence, imaging features, and clinical correlates of the \u201cFloating Lotus\u201d sign were assessed. Results: The \u201cFloating Lotus\u201d sign was observed in 48 patients (27.9%). It manifested as a mobile, echogenic mass within an anechoic space, revealing an underlying pericardial effusion. Patients exhibiting the sign had a higher prevalence of recent stroke (35.4% vs. 15.3%, p = 0.004), heart failure (64.6% vs. 8.1%, p &lt; 0.001), and larger left atrial diameter (44.3 \u00b1 6.8 vs. 39.7 \u00b1 5.4 mm, p &lt; 0.001). In multivariable analysis, only heart failure (left ventricular ejection fraction (LVEF) &lt;55%) remained an independent predictor (odds ratio [OR] 14.39, 95% confidence interval [CI] 5.51\u201337.58, p &lt; 0.001). Lower LAA emptying velocity was independently associated with persistent AF, higher CHA2DS2-VASc score, and recent stroke (all p &lt; 0.05). Conclusion: The \u201cFloating Lotus\u201d sign is a common ICE pseudo-thrombus, often associated with heart failure. Accurate recognition of this sign, based on its dynamic imaging features, is therefore critical to prevent misdiagnosis and avoid unnecessary procedural cancellation or anticoagulation changes.<\/jats:p>","DOI":"10.31083\/rcm50367","type":"journal-article","created":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T14:57:11Z","timestamp":1790693831000},"source":"Crossref","is-referenced-by-count":0,"title":["The \u201cFloating Lotus\u201d Sign on Intracardiac Echocardiography: Characterization and Predictors of a Novel Left Atrial Appendage Pseudo-Thrombus"],"prefix":"10.31083","volume":"27","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7163-0021","authenticated-orcid":true,"given":"Liang","family":"Zhang","sequence":"first","affiliation":[{"name":"Department of Cardiology, Third Affiliated Hospital of Naval Medical University, 200438 Shanghai, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yanyan","family":"Bai","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Shidong Hospital, 200438 Shanghai, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yanhua","family":"Zhu","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Third Affiliated Hospital of Naval Medical University, 200438 Shanghai, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jianhua","family":"Sun","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Shidong Hospital, 200438 Shanghai, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Liuliu","family":"Feng","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Shidong Hospital, 200438 Shanghai, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jingyu","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Third Affiliated Hospital of Naval Medical University, 200438 Shanghai, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9975-3683","authenticated-orcid":true,"given":"Songqun","family":"Huang","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Changhai Hospital, Naval Medical University, 200433 Shanghai, China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"16242","published-online":{"date-parts":[[2026,9,4]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","unstructured":"Musotto G, Monteleone A, Vella D, Zuccarello B, Cannova R, Cook A, et al. 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