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The WATCHMAN Left Atrial Appendage Closure Device for Atrial Fibrillation
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Cardiac Amyloidosis With Right Atrial Appendage Thrombus Detected After Left Atrial Appendage Occlusion

Kenji Nakano1, Masato Fukunaga1, Akihiro Isotani1

  • 1Department of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan.

JACC. Case Reports
|April 4, 2025
PubMed

Insights

Left atrial appendage occlusion (LAAO) can prevent strokes, but cardiac amyloidosis (CA) patients may develop right atrial appendage (RAA) thrombus after stopping anticoagulants. Individualized assessment is crucial for safe anticoagulation management post-LAAO.

Area of Science:

  • Cardiology
  • Interventional Cardiology

Background:

  • Left atrial appendage occlusion (LAAO) offers an alternative to anticoagulation for stroke prevention.
  • Studies show high rates of anticoagulant discontinuation following LAAO.

Observation:

  • A patient with cardiac amyloidosis (CA) underwent LAAO and discontinued anticoagulation.
  • Incidental imaging revealed a thrombus in the right atrial appendage (RAA).
  • Anticoagulation was reinstituted, with no clinical events over a 1-year follow-up.

Findings:

  • LAAO is effective for stroke prevention in CA patients.
  • Cardiac amyloidosis is linked to a higher risk of intracardiac thrombus formation.
  • RAA thrombus is a potential complication after LAAO in CA patients.

Implications:

  • Discontinuation of anticoagulation post-LAAO requires careful consideration of RAA thrombus risk.
  • Individualized anticoagulation strategies are essential for high-risk CA patients undergoing LAAO.
Abstract

Keywords:
atrial fibrillationcardiac amyloidosisleft atrial appendage occlusion

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