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Related Experiment Video

Updated: Apr 29, 2026

The WATCHMAN Left Atrial Appendage Closure Device for Atrial Fibrillation
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Remote Tamponade After Percutaneous Left Atrial Appendage Closure.

Magdalene Au1, David Bobrowski2, Eslem Altin3

  • 1Division of Cardiology, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada.

JACC. Case Reports
|April 4, 2025
PubMed
Summary

Percutaneous left atrial appendage closure (LAAC) can rarely cause delayed hemorrhagic tamponade, a serious complication. Cardiac CT pre-screening may help identify patients at risk, especially those receiving nitinol plug devices.

Keywords:
atrial fibrillationcomplicationpericardial effusiontamponade

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Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Medical Devices

Background:

  • Percutaneous left atrial appendage closure (LAAC) is increasingly used for nonvalvular atrial fibrillation patients at high thromboembolic risk.
  • Patients with contraindications or high bleeding risk with oral anticoagulation are candidates for LAAC.

Observation:

  • A rare case of acute hemorrhagic tamponade occurred 7 months after LAAC.
  • Intraoperative findings revealed device-related microperforation of the left atrial appendage (LAA) and adjacent pulmonary artery erosion.

Findings:

  • Remote tamponade after LAAC is a rare (<1%) but potentially fatal complication.
  • Nitinol plug devices are associated with a higher incidence of remote tamponade compared to nitinol cage devices.

Implications:

  • Routine cardiac computed tomography (CT) and transesophageal echocardiography are recommended for preprocedural planning.
  • Pre-screening can identify patients at risk for delayed tamponade, guiding device selection and management strategies.
  • This vigilance is particularly crucial for nitinol plug devices.