Percutaneous left atrial appendage closure in a patient with atrial fibrillation and osler-weber-rendu disease

Area of Science:

• Cardiology
• Interventional Cardiology
• Vascular Medicine

Background:

• Atrial fibrillation (AF) poses a significant stroke risk, often managed with anticoagulation.
• Osler-Weber-Rendu disease (Hereditary Hemorrhagic Telangiectasia) is associated with bleeding complications.
• Anticoagulation in patients with bleeding disorders like HHT can be challenging, increasing risks of severe anemia and transfusions.

Observation:

• A 79-year-old woman with permanent atrial fibrillation and Osler-Weber-Rendu disease presented with recurrent gastrointestinal bleeding, epistaxis, and hemarthrosis.
• Anticoagulation therapy for AF significantly exacerbated her bleeding episodes, leading to severe anemia and requiring multiple blood transfusions.
• The patient had a history of mesenteric embolism necessitating small bowel resection.

Findings:

• Percutaneous left atrial appendage occlusion (LAAO) using a Watchman 30 mm device was successfully performed.
• The LAAO procedure was technically successful, providing an alternative to long-term anticoagulation.
• Post-procedure, the patient experienced no thromboembolic events, epistaxis, or severe bleeding during long-term follow-up.

Implications:

• Left atrial appendage occlusion is a viable therapeutic option for AF patients with high bleeding risks due to conditions like Osler-Weber-Rendu disease.
• LAAO can mitigate the need for anticoagulation, thereby preventing treatment-related bleeding complications.
• This case highlights the potential of LAAO to improve quality of life and reduce healthcare utilization in complex patient populations.