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Updated: Jul 1, 2025
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The WATCHMAN Left Atrial Appendage Closure Device for Atrial Fibrillation
Published on: February 28, 2012
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A case report of postcardioversion device-related thrombus in a patient with left atrial appendage occlusion device
Hasaan Ahmed1, Mahmoud Ismayl2, Anirudh Palicherla1
1Department of Medicine, Division of Internal Medicine.
Annals of Medicine and Surgery (2012)
|March 11, 2024
Summary
Transesophageal echocardiography (TEE) may be necessary before repeat cardioversion, even in patients on anticoagulation. A case revealed a new thrombus in a patient with atrial fibrillation and a left atrial appendage occlusion device, highlighting risks beyond current guidelines.
Area of Science:
- Cardiology
- Electrophysiology
- Medical Devices
Background:
- Current guidelines suggest cardioversion without routine preprocedural transesophageal echocardiography (TEE) for patients on anticoagulation.
- The efficacy of these guidelines for repeat cardioversion is not well-established.
Observation:
- A 66-year-old male with atrial fibrillation (AF) and a left atrial appendage occlusion (LAAO) device developed a new left atrial thrombus.
- This occurred despite being compliant with anticoagulation and having a prior unremarkable TEE before an initial cardioversion.
Findings:
- The patient's TEE revealed a new 2 cm x 1 cm thrombus in the left atrium, above the WATCHMAN device.
- This finding led to the cancellation of a scheduled repeat cardioversion.
Implications:
- Anticoagulation may not fully mitigate thrombus risk in patients with stroke risk factors or LAAO devices.
- Further research is needed to determine the necessity of routine TEE after cardioversion in high-risk patients.
