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Updated: Sep 9, 2025
Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation
Published on: February 26, 2013
Intraprocedural Thrombus Formation During Left Atrial Appendage Closure: A Conservative Approach
Benjamin M Easow1, Rowan Bandaranaike1, Tijin Mathew1
1Internal Medicine Residency Program, Southeast Health, Dothan, Alabama, USA.
Background:
Left atrial appendage closure with the Watchman FLX Pro device (Boston Scientific) is an alternative to anticoagulation in patients at high bleeding risk with atrial fibrillation. Intraprocedural thrombus formation is rare and poses a unique challenge.
Case Summary:
A 57-year-old man with paroxysmal atrial fibrillation and prior intracranial hemorrhage underwent elective left atrial appendage closure. The Watchman FLX Pro was recaptured twice and was successfully deployed on the third attempt. Shortly after deployment, thrombus was noted at the device's threaded insert. The patient remained hemodynamically stable and was managed conservatively with intravenous heparin. Follow-up imaging confirmed thrombus resolution without embolic complications.
Discussion:
Device-related thrombus is typically recognized on follow-up imaging, with few reports of acute intraprocedural formation. This case offers insight into real-time thrombus development during Watchman FLX Pro implantation and highlights a successful nonsurgical strategy that may guide management in similar high-risk patients.
Take-Home Messages:
Multiple recaptures may increase thrombotic risk. Conservative anticoagulation can be effective for managing a stable, tethered thrombus.
