Successful New Generation LAA Closure Device Implantation After Prior Incomplete Surgical LAA Ligation

Abstract Background Late-onset complications of left atrial appendage occlusion (LAAO) device procedure are anecdotal and there are no such complications reported in literature using Cardia Ultraseal (Cardia, Inc., Eagan, MN, USA). Case summary We report the case of a 74-year-old Caucasian man affected by paroxysmal atrial fibrillation with significant bleeding risk (familiar thrombocytopenia, macroscopic haematuria episodes during therapy with direct oral anticoagulants, HAS-BLED risk score: 4) and ischaemic risk as well (CHADSVASC score: 3). The patient was treated with LAAO device implantation for high bleeding risk. Subsequently, after 26 days from LAAO procedure, he was admitted to the emergency department for haematic cardiac tamponade. The patient was successfully treated with subxyphoidal pericardiocentesis in the acute phase, unfortunately cardiac arrest occurred during the transfer to the referral hospital for urgent cardiac surgery. Permanent neurological damage was reported and the patient died on day 28. Discussion LAAO late-onset complications are very rare and the case presented is the first case described of late-onset pericardial effusion and tamponade secondary to the Cardia Ultraseal LAAO device implantation. We present a revision of the literature regarding the occurrence of similar adverse events and discuss the hypothetical mechanism of this major complication.

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Cardiac CT Prior to Left Atrial Appendage Closure Device Implantation and Percutaneous Mitral Valve Interventions

Current Cardiovascular Imaging Reports ◽

10.1007/s12410-014-9295-8 ◽

2014 ◽

Vol 7 (11) ◽

Author(s):

Swaminatha V. Gurudevan ◽

Reza Arsanjani

Keyword(s):

Mitral Valve ◽

Left Atrial ◽

Cardiac Ct ◽

Left Atrial Appendage ◽

Atrial Appendage ◽

Closure Device ◽

Left Atrial Appendage Closure ◽

Device Implantation

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Image fusion of integrating fluoroscopy into 3D computed tomography in guidance of left atrial appendage closure

European Heart Journal - Cardiovascular Imaging ◽

10.1093/ehjci/jez286 ◽

2019 ◽

Vol 22 (1) ◽

pp. 92-101 ◽

Cited By ~ 1

Author(s):

Bin-Feng Mo ◽

Yi Wan ◽

Abudushalamu Alimu ◽

Jian Sun ◽

Peng-Pai Zhang ◽

...

Keyword(s):

Computed Tomography ◽

Image Fusion ◽

Left Atrial ◽

Left Atrial Appendage ◽

Atrial Appendage ◽

Control Group ◽

Closure Device ◽

Transseptal Puncture ◽

3D Computed Tomography ◽

Laa Closure

Abstract Aims We evaluated the feasibility of left atrial appendage (LAA) closure guided by the image fusion of integrating fluoroscopy into 3D computed tomography (CT). Methods and results A total of 117 consecutive patients who underwent LAA closure with or without the image fusion were matched (1:2). Each LAA closure step of the Image fusion group was guided by the preprocedure CT and image fusion, especially in the plan of LAA measurement and transseptal puncture. All patients were successfully implanted with a WATCHMAN closure device. Comparing the two groups, the mean number of recapture times and the number of devices per patient of the Image fusion group were significantly lower (0.4 ± 0.5 vs. 0.7 ± 0.8, P = 0.031 and 1.0 ± 0.2 vs. 1.1 ± 0.3, P = 0.027, respectively). The one-time successful deployment rate by the support of the image fusion was higher than in the control group (66.7% vs. 44.9%, P = 0.026). Each case of the Image fusion group was completely occluded with one transseptal puncture, while five of the Non-image fusion group required redo transseptal punctures. During the 45-day follow-up, both group cases presented occlusion efficiency and no major adverse cardiac events were observed. Conclusion Image fusion technique integrating fluoroscopy into the 3D CT is safe and feasible which can be easily incorporated into the procedural work-flow of percutaneous LAA closure. The fusion image can play an important alternative role in the plan of LAA measurement and transseptal puncture site for improving the LAA closure procedure.

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P998Left atrial appendage closure device thrombosis is associated with systemic embolization

European Heart Journal ◽

10.1093/eurheartj/ehz747.0591 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

P Hala ◽

V Lekesova ◽

T Mraz ◽

M Prokopova ◽

J Petru ◽

...

Keyword(s):

Left Atrial Appendage ◽

Dual Antiplatelet Therapy ◽

Thrombus Formation ◽

Atrial Appendage ◽

Closure Device ◽

Device Implantation ◽

Occlusion Device ◽

Systemic Embolization ◽

Annual Risk

Abstract Introduction Atrial fibrillation, in one of its forms, is the most frequent sustained tachyarrhythmia and increases the risk of stroke more than 5 times. Cardioembolic stroke and systemic embolism (CS/SE) represents the most severe complication of this arrhythmia. Approximately 92% of intracardiac thrombosis originates from the left atrial appendage (LAA) and, although its mechanical occlusion is proved method to prevent cardioembolism, thrombosis of all types of LAA occlusion devices and their associations with CS/SE were observed. The purpose of this study is to evaluate the rate of LAA occlusion device thrombosis, its predictors and the risk for cardioembolism. Methods We analyzed a group of 359 patients (65% male, mean age 72 years) with high risk for thromboembolism (mean CHADSVASc = 4.0) after LAA catheter occlusion using any of 9 different occluder types since 2005. During clinical follow-up 819 patientyears were collected and an intracardiac thrombus was found on 22 devices. Total of 17 patients suffered CS/SE. Results Thrombosis was found in 11 men and 11 women, mean age 76 years, average CHADSVASc = 4.5 and HASBLED = 2.0. The thrombus was discovered on average 4.0 months after the LAA occlusion. In that time patients were receiving dual antiplatelet therapy (11x), acetysalicic acid (4x), or interrupted anticoagulation (6x). In 3 cases the thrombosis was associated with CS/SE which represented risk of 6.6% per year. In patients with no thrombosis annual risk of CS/SE was only 1.7% (P<0.001). Figure 1 Conclusion In our single center register thrombosis was found in total of 6.3% patients after LAA device implantation. In these patients, risk of CS/SE is 3.9-fold higher compared to patients without thrombus formation. Elderly patients and patients with more risk factors in general were affected more frequently.

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Left atrial appendage closure device implantation in patients at very high risk for stroke

Heart Rhythm ◽

10.1016/j.hrthm.2019.07.011 ◽

2020 ◽

Vol 17 (1) ◽

pp. 27-32 ◽

Cited By ~ 3

Author(s):

Erika Hutt ◽

Oussama M. Wazni ◽

Simrat Kaur ◽

Walid I. Saliba ◽

Khaldoun G. Tarakji ◽

...

Keyword(s):

High Risk ◽

Left Atrial ◽

Left Atrial Appendage ◽

Atrial Appendage ◽

Closure Device ◽

Left Atrial Appendage Closure ◽

Device Implantation ◽

Very High

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Contrast Enhanced Transesophageal Echocardiographic Guidance of Left Atrial Appendage Closure Device Implantation

Journal of the American Society of Echocardiography ◽

10.1016/j.echo.2010.02.009 ◽

2010 ◽

Vol 23 (9) ◽

pp. 1007.e3-1007.e4 ◽

Cited By ~ 1

Author(s):

Michael L. Main ◽

George G. Latus ◽

Anthony Magalski ◽

Kenneth C. Huber

Keyword(s):

Left Atrial ◽

Left Atrial Appendage ◽

Atrial Appendage ◽

Closure Device ◽

Left Atrial Appendage Closure ◽

Device Implantation ◽

Contrast Enhanced

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Left atrial appendage perforation during appendage angiography treated by percutaneous left atrial appendage closure: a case report

European Heart Journal - Case Reports ◽

10.1093/ehjcr/ytab187 ◽

2021 ◽

Vol 5 (5) ◽

Author(s):

Catherine Champagne ◽

Nicolas Dognin ◽

Josep Rodés-Cabau ◽

Jean Champagne

Keyword(s):

Case Report ◽

Pericardial Effusion ◽

Left Atrial ◽

Left Atrial Appendage ◽

Atrial Appendage ◽

Closure Device ◽

Left Atrial Appendage Closure ◽

Case Summary ◽

Device Deployment ◽

Laa Closure

Abstract Background Pericardial effusion is a common complication of percutaneous left atrial appendage (LAA) closure. Acute management is the cornerstone of pericardial effusion treatment and interrupting the intervention is often required. Case summary A 65-year-old man presented an acute 10 mm pericardial effusion following pigtail contrast appendage injection. A rapid Watchman Flex 24 mm (Boston Scientific) deployment permitted bleeding interruption. A needle pericardiocentesis was achieved in order to prevent any haemodynamical instability. Discussion This case report describes an atypical cause of pericardial effusion and a technique for bleeding control with LAA closure device deployment.

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Late left atrial appendage closure device displacement and massive thrombus formation: a case report

European Heart Journal - Case Reports ◽

10.1093/ehjcr/ytaa014 ◽

2020 ◽

Vol 4 (2) ◽

pp. 1-5 ◽

Cited By ~ 1

Author(s):

Benjamin Sasko ◽

Oliver Ritter ◽

Peter Bramlage ◽

Fabian Riediger

Keyword(s):

Left Atrial ◽

Left Atrial Appendage ◽

Thrombus Formation ◽

Anticoagulation Therapy ◽

Bleeding Risk ◽

Atrial Appendage ◽

Closure Device ◽

Watchman Device ◽

High Bleeding Risk ◽

Laa Closure

Abstract Background Left atrial appendage (LAA) closure with the WATCHMAN device is an alternative to anticoagulation therapy for the prevention of stroke in selected patients with atrial fibrillation (AF). Infrequently, left atrial (LA) device-related thrombus formation occurs and it is poorly understood. Thrombus formation due to incomplete covering of the LAA is even rarer and may occur within the first few months after device implantation. Case summary Here, we present a case of a 68-year-old male patient with permanent AF, drug- and hepatitis induced liver cirrhosis (CILD Score B), and prior aortic valve replacement. The patient had a history of percutaneous LAA closure using a WATCHMAN device. He developed massive peri-device leak and thrombus arising from the space between the device and appendage cleft 2 years after implantation. Because of the high bleeding risk with a HAS-BLED score of 5 points, surgery was chosen as the therapy of choice instead of long-term anticoagulation. The patient was discharged in good clinical condition and has been scheduled for a yearly follow-up. Discussion This case emphasizes the importance of choosing appropriately sized LAA occluder devices and planning for regular post-interventional follow-ups to minimize the risk of per-device leaks and thrombi.

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