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Updated: Dec 12, 2025
The WATCHMAN Left Atrial Appendage Closure Device for Atrial Fibrillation
Published on: February 28, 2012
Reoccurrence of Stroke in a Patient With Peri-Device Leak of WATCHMAN Device
Jordan Perkins1, Riwaj Bhagat1, Matthew Nichols1
1University of Louisville, Louisville, KY, USA.
Insights
Left atrial appendage closure with the WATCHMAN device aims to prevent stroke in atrial fibrillation patients. However, this case shows stroke risk persists even after implantation, questioning the management of device leaks.
Area of Science:
- Cardiology
- Neurology
- Medical Devices
Background:
- Atrial fibrillation is a primary cause of cardioembolic stroke.
- The left atrial appendage is a common source of emboli.
- Left atrial appendage closure devices, like WATCHMAN, are used to mitigate this risk.
Observation:
- A 71-year-old male with atrial fibrillation underwent WATCHMAN implantation due to stroke risk and bleeding concerns.
- Over a year later, the patient experienced a recurrent stroke.
- Imaging revealed a 1.8-mm peri-device leak, though initial implantation was deemed successful.
Findings:
- Recurrent cardioembolic stroke occurred despite successful WATCHMAN device implantation.
- A small peri-device leak was present post-implantation.
- The significance of peri-device leaks in relation to recurrent stroke requires further investigation.
Implications:
- Patients with atrial fibrillation remain at risk for stroke even after left atrial appendage closure.
- The clinical significance of minimal peri-device leaks warrants further study.
- Current management strategies for peri-device leaks and anticoagulation in this population may need re-evaluation.
Abstract:
Atrial fibrillation is the leading cause of cardioembolic stroke, with emboli most commonly originating from the left atrial appendage. We report the case of a 71-year-old male with left atrial appendage closure via implantation of the WATCHMAN device, due to possible anticoagulation therapy failure and increased bleeding risk, following a stroke. Following a new stroke over a year later, a 1.8-mm peri-device leak was observed. Surgical records noted a minimal (<5 mm jet flow) peri-device leak after the installation, which was considered successful WATCHMAN implantation per protocol. This case highlights the persistent risk of cardioembolic stroke in patients with nonvalvular atrial fibrillation despite device implantation and questions the significance of peri-device leak and further management with anticoagulation for recurrent stroke.
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