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Updated: Jan 25, 2026

Reduction of Iatrogenic Atrial Septal Defects with an Anterior and Inferior Transseptal Puncture Site when Operating the Cryoballoon Ablation Catheter
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The cryoballoon as a bailout in a severely perforated left atrial appendage: a case report

Andreas Metzner1, Feifan Ouyang1, Felix Kreidel1

  • 1Department of Cardiology, Asklepios-Klinik St. Georg, Lohmühlenstr. 5, Hamburg, Germany.

European Heart Journal. Case Reports
|April 26, 2019
PubMed

Insights

A novel approach using a cryoballoon and epicardial suture device successfully treated a perforated left atrial appendage (LAA) during occlusion procedures. This combination offers an emergency solution for LAA perforation, preventing open-heart surgery.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Medical Device Technology

Background:

  • Left atrial appendage (LAA) occlusion is a common procedure for atrial fibrillation patients on anticoagulation.
  • Patients with contraindications or complications from oral anticoagulation often undergo LAA occlusion.
  • Electrical LAA isolation is another indication for LAA occlusion procedures.

Observation:

  • An attempted endocardial LAA occlusion led to distal LAA perforation and severe pericardial tamponade.
  • A cryoballoon was deployed to the LAA base, achieving occlusion and halting pericardial bleeding.
  • An epicardial LAA suture device was subsequently implanted, completely sealing the LAA.

Findings:

  • The combined cryoballoon and epicardial suture device approach successfully managed LAA perforation.
  • This technique prevented the need for emergency open-heart surgery.
  • The patient experienced a full recovery with no further bleeding.

Implications:

  • This combined device strategy presents a viable emergency bail-out option for iatrogenic LAA perforation.
  • It offers a less invasive alternative to surgery in complex LAA occlusion cases.
  • Further research may explore the broader application of this technique in managing LAA-related complications.
Abstract

Keywords:
Case reportCryoballoonEpicardial ligationLariatLeft atrial appendagePerforation

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