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Updated: Aug 17, 2026
The WATCHMAN Left Atrial Appendage Closure Device for Atrial Fibrillation
Published on: February 28, 2012
Percutaneous Rescue With Sequential Second-Device Usage for Left Atrial Appendage Perforation During Amulet
Masanori Yamamoto1, Ryo Yamaguchi2, Tatsuya Tsunaki3
1Department of Cardiology, Toyohashi Heart Center, Toyohashi, Japan; Department of Cardiology, Gifu Heart Center, Gifu, Japan; Department of Cardiology, Nagoya Heart Center, Nagoya, Japan.
Background:
Left atrial appendage closure (LAAC) prevents stroke in nonvalvular atrial fibrillation, while device-related left atrial appendage (LAA) perforation may lead to cardiac tamponade.
Case Summary:
A man in his early 80s underwent percutaneous LAAC using the Amulet device. During deployment, sustained counterclockwise torque in a ball-shaped configuration resulted in perforation of the LAA, with device extrusion and progressive pericardial effusion. To avoid bleeding upon extraction, we executed a sequential second-device rescue: The first device was left in situ to tamponade the defect, while a downsized Amulet was positioned at the orifice; the first device was then withdrawn, and the second device was released immediately, sealing the LAA. Ultimately, the patient was discharged uneventfully.
Discussion:
Sheath rotation in a ball configuration is generally considered safe, while excessive torque can make this maneuver risky.
Take-Home Message:
LAAC itself can treat acute perforation by sealing both the defect and the LAA before considering surgery.
