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

Atrial fibrillation significantly increases the risk of thromboembolic events, necessitating anticoagulation for stroke prevention. However, patients with a history of intracranial hemorrhage pose unique management challenges, particularly regarding the use of anticoagulants and the need for dual antiplatelet therapy following procedures like percutaneous coronary intervention. In addition, the occurrence of bradyarrhythmias often necessitates pacing, underscoring the importance of innovative strategies such as left atrial appendage closure devices and leadless pacemakers to manage atrial fibrillation effectively while minimizing hemorrhagic risks. A 61-year-old man with permanent atrial fibrillation, recent intracerebral hemorrhage, and bradycardia presented with dizziness and recurrent syncopal episodes. During hospitalization, he underwent coronary angiography and percutaneous coronary intervention with drug-eluting stent placement in the left anterior descending and right coronary arteries. Due to anticoagulation risks, he subsequently underwent left atrial appendage closure with the LAmbreTM device and received an AveirTM leadless pacemaker. Both procedures were successful, and he was discharged in stable condition. This case highlights how a combination of left atrial appendage closure, leadless pacing, and coronary intervention provided effective stroke prevention, heart rate control, and ischemic management in a high-risk atrial fibrillation patient. These strategies avoided the prolonged use of anticoagulants while addressing the patient's cardiovascular and hemorrhagic risk.