Case report: peri-device leakage after percutaneous left atrial appendage occlusion: plug, clip, or amputate?

Nawin L. Ramdat Misier, Rohit K. Kharbanda, Frank R.N. Van Schaagen, Natasja M.S. De Groot*

*Corresponding author for this work

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Background: Although peri-device leakage is frequently observed after left atrial appendage occlusion (LAAO), there is no consensus on the optimal management strategy. It is unknown whether additional plugging should be preferred over surgical exclusion of the LAA, as experience with additional plugging is limited. Case summary: In this case report, we demonstrate the clinical implications of additional plugging and surgical exclusion in a 65-year-old male patient with peri-device leakage and recurrent thromboembolic events. After the recurrence of paroxysmal atrial fibrillation (AF) and a transient ischaemic attack despite adequate anticoagulation, the patient was opted for re-do pulmonary vein isolation and LAAO with a Watchman device. Due to multiple ischaemic strokes and recurrent AF in combination with significant peri-device leakage, additional plugging with a second device was performed. Post-procedurally, the patient had another ischaemic stroke and persisting peri-device leakage was observed during follow-up. Due to progressive symptoms of AF and patient's preference to discontinue DOAC, he underwent a Cox MAZE IV procedure, including amputation of the LAA with both devices. Within six months after surgery, the patient experienced two more ischaemic events. In the following two years, the patient remained free of any cerebrovascular accidents or recurrence of AF. Discussion: Additional plugging of peri-device leakage is not always successful in stroke prevention. In combination with recurrent AF, progressive symptoms, contraindication for oral anticoagulation, and patient's preference, surgical LAA exclusion could be preferred over additional plugging.

Original languageEnglish
Article numberytac494
JournalEuropean Heart Journal - Case Reports
Issue number1
Publication statusPublished - Jan 2023

Bibliographical note

Funding Information:
N.M.S. de Groot, MD, PhD is supported by funding grants from Dutch Cardiovascular Alliance [grant number 914728], Nederlandse Organisatie voor Wetenschappelijk Onderzoek [grant number 91717339], Biosense Webster USA [ICD 783454] and Medical Delta

Publisher Copyright:
© 2023 The Author(s). Published by Oxford University Press on behalf of the European Society of Cardiology.


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