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Updated: Dec 22, 2025
Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation
Published on: February 26, 2013
Late left atrial appendage closure device displacement and massive thrombus formation: a case report
Benjamin Sasko1, Oliver Ritter1, Peter Bramlage1,2
1Department of Internal Medicine I - Cardiology, Brandenburg Medical Faculty, Hochstr. 29, 14770 Brandenburg/Havel, Germany.
Insights
Left atrial appendage (LAA) closure with WATCHMAN devices can lead to rare thrombus formation. Careful device sizing and regular follow-ups are crucial to prevent complications like peri-device leaks and thrombi after LAA closure.
Area of Science:
- Cardiology
- Interventional Cardiology
- Medical Devices
Background:
- Left atrial appendage (LAA) closure using the WATCHMAN device is an alternative to anticoagulation for stroke prevention in atrial fibrillation (AF).
- Device-related thrombus formation in the left atrium (LA) is an infrequent complication.
- Thrombus formation due to incomplete LAA coverage is rare and can occur early post-implantation.
Purpose of the Study:
- To present a rare case of massive peri-device leak and thrombus formation 2 years after WATCHMAN device implantation.
- To highlight the management of LAA device complications in a patient with high bleeding risk.
Main Methods:
- Case report of a 68-year-old male with permanent AF, liver cirrhosis, and prior aortic valve replacement.
- Patient underwent percutaneous LAA closure with a WATCHMAN device.
- Management involved surgical intervention due to high bleeding risk (HAS-BLED score of 5).
Main Results:
- The patient developed a massive peri-device leak and thrombus originating from the space between the device and the LAA cleft.
- Surgery was successfully performed, and the patient was discharged in good condition.
- A yearly follow-up schedule was arranged.
Conclusions:
- This case underscores the significance of selecting appropriately sized LAA occluder devices.
- Regular post-interventional follow-ups are essential for early detection and management of peri-device leaks and thrombi.
Background:
Left atrial appendage (LAA) closure with the WATCHMAN device is an alternative to anticoagulation therapy for the prevention of stroke in selected patients with atrial fibrillation (AF). Infrequently, left atrial (LA) device-related thrombus formation occurs and it is poorly understood. Thrombus formation due to incomplete covering of the LAA is even rarer and may occur within the first few months after device implantation.
Case Summary:
Here, we present a case of a 68-year-old male patient with permanent AF, drug- and hepatitis induced liver cirrhosis (CILD Score B), and prior aortic valve replacement. The patient had a history of percutaneous LAA closure using a WATCHMAN device. He developed massive peri-device leak and thrombus arising from the space between the device and appendage cleft 2 years after implantation. Because of the high bleeding risk with a HAS-BLED score of 5 points, surgery was chosen as the therapy of choice instead of long-term anticoagulation. The patient was discharged in good clinical condition and has been scheduled for a yearly follow-up.
Discussion:
This case emphasizes the importance of choosing appropriately sized LAA occluder devices and planning for regular post-interventional follow-ups to minimize the risk of per-device leaks and thrombi.
