Left Atrial Appendage (LAA) Closure-Device Disengagement as a Serious Complication and How it Can Be Easily Removed

Area of Science:

• Cardiology
• Neurology
• Interventional Cardiology

Background:

• Atrial fibrillation (AF) is a common arrhythmia associated with a high risk of stroke.
• Brainstem strokes are severe neurological events, and anticoagulation therapy for AF can lead to complications like arterial bleeding.
• Left atrial appendage (LAA) occlusion is an alternative to anticoagulation for stroke prevention in AF patients.

Purpose of the Study:

• To report a rare case of LAA closure device embolization after LAA occlusion in a patient with paroxysmal AF.
• To describe the successful retrieval of an embolized LAA closure device from systemic circulation.
• To highlight the management of complications following LAA occlusion procedures.

Main Methods:

• A 51-year-old woman with paroxysmal AF (CHADS(2) score 3) presented with a brainstem stroke.
• Anticoagulation therapy was complicated by arterial bleeding, leading to the decision for LAA occlusion.
• Following LAA occlusion, device embolization occurred and the device was subsequently located and removed.

Main Results:

• The patient developed a brainstem stroke, a serious complication of AF.
• Arterial bleeding occurred as a complication of anticoagulation therapy.
• Left atrial appendage (LAA) closure device embolization occurred post-procedure, but the device was successfully retrieved from the systemic circulation.

Conclusions:

• Left atrial appendage (LAA) occlusion can be a viable alternative for stroke prevention in AF patients, even with contraindications to anticoagulation.
• Device embolization is a rare but potential complication of LAA occlusion procedures.
• Successful retrieval of embolized devices is achievable, underscoring the importance of interventional expertise.