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Updated: Jul 2, 2025
The WATCHMAN Left Atrial Appendage Closure Device for Atrial Fibrillation
Published on: February 28, 2012
Circumflex to Left Atrial Appendage Fistula Associated With Watchman FLX Closure Device
Stefan Milutinovic1, Juan Lopez-Mattei2, Jeffrey Rosen2,3
1Florida State University College of Medicine Internal Medicine Residency Program at Lee Health, Cape Coral, Florida, USA.
Insights
A Watchman FLX device implantation complication led to a fistula between the left circumflex artery and the left atrial appendage. This rare event caused dyspnea in an elderly patient, highlighting potential risks of cardiac device procedures.
Area of Science:
- Cardiology
- Interventional Cardiology
- Medical Device Complications
Background:
- The Watchman FLX device is used for left atrial appendage closure.
- Complications following device implantation require thorough investigation.
Purpose of the Study:
- To report a rare complication of Watchman FLX device implantation.
- To describe the diagnostic evaluation of a post-procedural fistula.
Main Methods:
- Case report of an 82-year-old male patient.
- Multimodality imaging for fistula diagnosis.
- Review of anatomical proximity between the left circumflex artery and left atrial appendage.
Main Results:
- A small fistula was identified between the proximal circumflex artery and the left atrial appendage.
- The patient presented with dyspnea following Watchman FLX device implantation.
- Anatomical proximity supports fistula formation as a late complication.
Conclusions:
- Fistula formation is a potential, albeit rare, late complication of Watchman FLX device implantation.
- Multimodality evaluation is crucial for diagnosing such complications.
- Understanding anatomical relationships is key to anticipating device-related risks.
Abstract:
An 82-year-old man who had undergone Watchman FLX (Boston Scientific) device implantation presented with dyspnea. Multimodality evaluation demonstrated a small fistula from the proximal circumflex artery to the left atrial appendage. Anatomically, the left circumflex artery is close to the atrial appendage; therefore, it is plausible that fistula formation could be a late complication of implantation of the device.
