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Percutaneous Retrieval of Free-Floating Amulet Device From Left Atrium
Amina Namrouti1, Elliott Elias2, Ramon Quesada2
1Herbert Wertheim College of Medicine, Florida International University, Miami, Florida, USA.
Insights
Device embolization after left atrial appendage closure is rare but serious. This case demonstrates successful percutaneous retrieval of an embolized Amulet device, offering a viable treatment option.
Area of Science:
- Cardiology
- Interventional Cardiology
- Medical Device Technology
Background:
- Atrial fibrillation (AF) increases stroke risk, leading to left atrial appendage (LAA) closure as an alternative to anticoagulation.
- LAA occluder devices, like the Amulet, aim to prevent thromboembolic events but carry a risk of complications such as device embolization.
Observation:
- An 81-year-old female patient with persistent AF and comorbidities experienced embolization of an Amulet LAA occluder device post-implantation.
- Transthoracic echocardiogram confirmed device embolization within the left atrium.
Findings:
- A percutaneous retrieval of the embolized Amulet device was successfully performed using an Amplatz Gooseneck Snare and MitraClip transseptal sheath.
- The retrieval was achieved via a transseptal approach through the right femoral vein.
Implications:
- Device embolization, though rare (approx. 0.07% incidence), requires prompt and effective management.
- Percutaneous transseptal retrieval is a feasible and successful strategy for managing embolized LAA closure devices.
- This case highlights the importance of a multidisciplinary approach in managing LAA device complications.
Abstract:
Atrial fibrillation (AF) is a common cardiac arrhythmia, significantly increasing the risk of thromboembolic events, particularly cerebral vascular accidents. Left atrial appendage occluder devices have been introduced as an alternative to anticoagulation therapy for stroke prevention in AF patients, but their use can be complicated by device embolization. This report details the case of an 81-year-old woman with persistent AF, chronic immune thrombocytopenic purpura, and various other comorbidities, who underwent a left atrial appendage closure using an Amulet device. Despite the successful initial placement, a subsequent transthoracic echocardiogram revealed device embolization within the left atrium. A percutaneous retrieval was successfully performed using an Amplatz Gooseneck Snare and a MitraClip transseptal sheath via the right femoral vein. The occurrence of device embolization, although rare (incidence approximately 0.07%), necessitates a multidisciplinary approach for effective management. Percutaneous retrieval of an embolized left atrial appendage closure device from the left atrium is feasible by a transseptal approach.
