Remote Tamponade After Percutaneous Left Atrial Appendage Closure

Abstract

Background: The use of percutaneous left atrial appendage closure (LAAC) among patients with nonvalvular atrial fibrillation at high thromboembolic risk and contraindication to or high risk for bleeding with oral anticoagulation is increasing.

Case summary: The authors present a case of acute hemorrhagic tamponade 7 months after LAAC. Intraoperative findings showed device-related microperforation of the LAA and erosion of the adjacent pulmonary artery.

Discussion: Remote tamponade after LAAC has been reported with an incidence <1%, occurring more frequently in nitinol plug devices than in nitinol cage devices. Management ranges from conservative with cessation of antithrombotic agents to invasive with surgical repair.

Take-home messages: Remote tamponade after LAAC is a rare but potentially fatal complication. Routine use of cardiac computed tomography in addition to transesophageal echocardiography for preprocedural planning, especially for nitinol plug devices, can identify patients at risk of delayed tamponade and can guide device selection, modified implantation technique, or alternative management strategies.

Keywords: atrial fibrillation; complication; pericardial effusion; tamponade.