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Updated: Aug 17, 2026
The WATCHMAN Left Atrial Appendage Closure Device for Atrial Fibrillation
Published on: February 28, 2012
Rescate Percutáneo con Uso Secuencial de un Segundo Dispositivo para Perforación de la Aurícula Izquierda Durante la
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left in situ to tamponade the defect, while a downsized Amulet was positioned at the orifice; the first device was then withdrawn, and the second device was released immediately, sealing the LAA.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.
