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Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation
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Recurrent syncope after left atrial appendage occlusion.

Ignacio Cruz-Gonzalez1, Jose-Angel Perez-Rivera, Armando Bethencourt

  • 1Division of Cardiology, University Hospital of Salamanca, Spain.

Catheterization and Cardiovascular Interventions : Official Journal of the Society for Cardiac Angiography & Interventions
|July 22, 2014
PubMed
Summary

Recurrent syncope, a rare complication, occurred after left atrial appendage (LAA) occlusion in a patient with atrial fibrillation. Surgical removal of the LAA occlusion device resolved the symptoms.

Keywords:
complicationsleft atrial appendage occlusionsyncope

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Area of Science:

  • Cardiology
  • Interventional Cardiology

Background:

  • Atrial fibrillation necessitates anticoagulation, but contraindications exist.
  • Left atrial appendage (LAA) occlusion is an alternative for stroke prevention.
  • Device selection and placement are critical for procedural success.

Observation:

  • A 72-year-old woman with atrial fibrillation and anticoagulation contraindication underwent LAA occlusion.
  • A 24-mm Amplatzer Cardiac Plug was deployed, with initial mitral valve assessment showing no significant issues.
  • Post-procedure, the patient experienced recurrent syncope upon standing, with symptoms of hypotension and tachycardia.

Findings:

  • Transesophageal echocardiography (TEE) did not reveal significant device migration or mitral valve dysfunction.
  • The patient's syncope was attributed to the LAA occlusion device, potentially due to positional effects or occult hemodynamic compromise.
  • Surgical removal of the LAA occlusion device and LAA exclusion successfully resolved the patient's symptoms.

Implications:

  • This case highlights recurrent syncope as a potential, previously undescribed complication of LAA occlusion.
  • Careful patient selection and post-procedural monitoring are essential for LAA occlusion.
  • Surgical intervention may be necessary for managing rare device-related complications.