Late-Onset Pericardial Effusion and Device Extrusion After Left Atrial Appendage Occluder Implantation

We present a case of Watchman device extrusion from left atrial appendage (LAA) free wall 6 months after implantation in a patient with longstanding persistent atrial fibrillation.

A 74-year-old male with longstanding persistent atrial fibrillation of 15 years duration was implanted with a Watchman device as he cannot be on long-term oral anticoagulation due to a history of multiple falls. Six months post implantation, repeat transesophageal echocardiogram revealed a thrombus on the epicardial aspect of LAA and a large posterior pericardial effusion. The patient subsequently underwent surgical removal of both the LAA and the protruding Watchman device.

In the case we present, the patient developed a clinically significant pericardial effusion 6 months after the Watchman device implantation, accompanied by left atrial extrusion, which was not reported to our knowledge.

Complications of Watchman devices respect no timeline boundaries and should be kept in mind when evaluating cardiac tamponade in patients with an implanted Watchman device.