Multi-modality approach to detect device-related thrombus after left atrial appendage occlusion: a case report
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Updated: Sep 11, 2025
Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation
Published on: February 26, 2013
Hamady I Maiga1, Jana Ambrožič1, Borut Jug2,3
1Department of Cardiology, University Medical Centre Ljubljana, Zaloška 7, Ljubljana 1000, Slovenia.
Insights
Left atrial appendage occlusion (LAAO) prevents stroke in atrial fibrillation (AF) patients. Device-related thrombus (DRT) is a rare complication, but multi-modality imaging aids diagnosis and treatment, leading to successful resolution.
Area of Science:
- Cardiology
- Medical Imaging
- Interventional Cardiology
Background:
- Left atrial appendage occlusion (LAAO) is an alternative stroke prevention strategy for atrial fibrillation (AF) patients unsuitable for oral anticoagulation.
- Device-related thrombus (DRT) is a potential complication of LAAO, presenting diagnostic and therapeutic challenges.
Observation:
- A case report details a patient with AF and intracranial hemorrhage who underwent LAAO implantation.
- Early transesophageal echocardiography (TOE) revealed a mass on the LAAO device, confirmed as thrombus by cardiac computed tomography angiography.
Findings:
- The patient experienced complete thrombus resolution at 6-month follow-up.
- The patient remained free of thromboembolic events and bleeding complications.
Implications:
- Accurate diagnosis of DRT is critical for effective treatment following LAAO.
- A multi-modality imaging approach, combining TOE and cardiac CT angiography, is valuable for diagnosing LAAO complications.
Background:
There has been a growing interest in using left atrial appendage occlusion (LAAO) for stroke prevention in patients with atrial fibrillation (AF) who are ineligible for oral anticoagulation. However, device-related thrombus (DRT) may occur after LAAO implantation and poses significant diagnostic and treatment challenges.
Case Summary:
We describe a case of a patient who suffered an intracranial pontine haemorrhage while on anticoagulation with rivaroxaban for permanent atrial fibrillation and successfully underwent implantation of the LAAO device. Early follow-up transoesophageal echocardiography (TOE) with 3D multi-plane reconstruction revealed a large echo-dense mass on the left atrial aspect of the device. Cardiac computed tomography angiography confirmed a thrombus adherent to the LAAO device. After deciding on the treatment strategy, complete thrombus resolution was achieved at the 6 months follow-up and the patient was free of any thromboembolic and bleeding events.
Discussion:
Although DRT is a rare complication following LAAO procedure, an accurate diagnosis is crucial for the specific treatment. Multi-modality imaging approach with TOE and cardiac computed tomographic angiography as complementary methods is helpful to detect complications after LAAO procedure in challenging cases.
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