Dual device intervention for stroke prevention and bradycardia: a case report

Area of Science:

• Cardiology
• Interventional Cardiology
• Electrophysiology

Background:

• Atrial fibrillation increases stroke risk, often requiring anticoagulation.
• Patients with intracranial hemorrhage history present challenges for anticoagulation and dual antiplatelet therapy.
• Bradyarrhythmias in atrial fibrillation patients may necessitate pacing.

Purpose of the Study:

• To present a case of managing a high-risk atrial fibrillation patient with a history of intracerebral hemorrhage.
• To highlight the use of innovative devices for stroke prevention and heart rate control.
• To demonstrate an alternative to long-term anticoagulation in complex cardiovascular cases.

Main Methods:

• A 61-year-old male with permanent atrial fibrillation, recent intracerebral hemorrhage, and bradycardia underwent percutaneous coronary intervention.
• The patient subsequently received a LAmbre™ left atrial appendage closure device and an Aveir™ leadless pacemaker.
• This combined approach aimed to prevent thromboembolic events and manage bradycardia while avoiding anticoagulation.

Main Results:

• Both the left atrial appendage closure and leadless pacemaker procedures were technically successful.
• The patient was discharged in stable condition, with effective stroke risk mitigation and heart rate control.
• The chosen strategy successfully avoided prolonged anticoagulation, addressing both cardiovascular and hemorrhagic risks.

Conclusions:

• Left atrial appendage closure and leadless pacing offer a viable alternative for stroke prevention and heart rate management in high-risk atrial fibrillation patients.
• These innovative device-based strategies can be safely employed in patients with contraindications to anticoagulation.
• This case underscores the importance of tailored, multi-faceted approaches for complex cardiovascular conditions.