Authors

• Luka Bastiančić — University of Rijeka School of Medicine, University Hospital Centre Rijeka, Rijeka, Croatia — ORCID: 0000-0002-6520-0287
• Ivana Smoljan — University of Rijeka School of Medicine, University Hospital Centre Rijeka, Rijeka, Croatia — ORCID: 0000-0002-9668-291X
• Tomislav Jakljević — University of Rijeka School of Medicine, University Hospital Centre Rijeka, Rijeka, Croatia — ORCID: 0000-0002-3692-0111
• Sandro Brusich — University of Rijeka School of Medicine, University Hospital Centre Rijeka, Rijeka, Croatia — ORCID: 0000-0001-7394-6698
• Vjekoslav Tomulić — University of Rijeka School of Medicine, University Hospital Centre Rijeka, Rijeka, Croatia — ORCID: 0000-0002-3749-5559
• Dimitrij Kuhelj — University Medical Centre Ljubljana, Ljubljana, Slovenia — ORCID: 0000-0003-3521-1564

Keywords

left atrial appendage, device, watchman, embolization

DOI

Full Text

**Introduction:** Left atrial appendage (LAA) closure is a percutaneous procedure used for prevention of thromboembolic events in patients with non-valvular atrial fibrillation with contraindication for oral anticoagulant therapy. (1, 2) In University Hospital Centre Rijeka we performed a total of 17 percutaneous LAA closure procedures using the Watchman® device (Boston Scientific). In this case report we describe a late complication of the procedure – device embolization. **Case report:** We report a case of a 62-year-old man with a persistent atrial fibrillation and a contraindication for anticoagulant therapy due to non-traumatic intracerebral bleeding. After initial assessment and pre-procedure transesophageal imaging including standard measurements, patient underwent percutaneous implantation of LAA closure device which was done with no early complications. On routine transesophageal echocardiographic follow-up 45 days after implantation no closure device was found in LAA, left atrium or ventricle and the visualized parts of the aorta. Patient was asymptomatic and the time of embolization was unknown. MSCT aortography (**Figure 1**) detected the device in abdominal aorta. Extraction was done via percutaneous right femoral artery approach using an Amplatz Goose Neck® Snare Kit. The device was removed completely with no complications. Figure 1. MSCT scan of the Watchman® (arrow) in abdominal aorta (1) and after extraction (2). **Conclusion:** Late embolization of a LAA closure device is a rare complication of the procedure. Depending on the localization, an embolized device can be successfully removed via percutaneous approach.

Literature

1. Aminian A, Lalmand J, Tzikas A, Budts W, Benit E, Kefer J. Embolization of left atrial appendage closure devices: A systematic review of cases reported with the watchman device and the amplatzer cardiac plug. Catheter Cardiovasc Interv. 2015;86:128–35. https://doi.org/10.1002/ccd.25891
2. Pison L, Potpara TS, Chen J, Larsen TB, Bongiorni MG, Blomström-Lundqvist C, Scientific Initiative Committee. European Heart Rhythm Association. Left atrial appendage closure-indications, techniques, and outcomes: results of the European Heart Rhythm Association Survey. Europace. 2015;17(4):642–6. https://doi.org/10.1093/europace/euv069