Objectives
We sought to provide a systematic review of reported cases of LAA closure device embolization by focusing on the two most commonly implanted devices: the Watchman (WM) device and the Amplatzer Cardiac Plug (ACP).

Methods
A comprehensive search of the Pubmed database was conducted until October 1, 2014. Studies were included if they described at least 1 case of embolization of the WM and/or the ACP.

Results
A total of 20 studies reporting 31 cases of device embolization were identified, including 13 cases with WM and 18 cases. The timing of embolization was described in 29 cases and was categorized as acute in 20 cases (65%) and late in 9 cases (30%). The anatomical location of embolized devices was reported in 21 cases: into the aorta in 9 cases, into the left ventricle (LV) in 9 cases and into the left atrial cavity in 3 cases. As compared to embolization into the aorta or the left atrial cavity, device embolization into the LV was associated with a higher rate of surgical retrieval (8/9 vs 2/12; 88% vs 17%, P = 0.0019). Major adverse events related to device embolization occurred in three patients (9.6%).

Conclusions
LAA closure device embolization occurs mainly in the periprocedural period but late embolizations are not uncommon. Although embolization into the aorta or the left atrium can be successfully managed by percutaneous techniques in most cases, device embolization into the LV is associated with a higher rate of surgical retrieval, increasing thereby procedure-related morbidity. © 2015 Wiley Periodicals, Inc.

Embolization of left atrial appendage closure devices: A systematic review of cases reported with the watchman device and the amplatzer cardiac plug.

Aims Left atrial appendage device occlusion is an increasingly accepted therapy for stroke prevention in atrial fibrillation. The feasibility and safety of left atrial catheter ablation procedures in the presence of a left atrial appendage device implant is unclear. We report on 10 cases of successful left atrial catheter ablation therapy for atrial fibrillation in patients with an implanted Watchman® device.

Methods and results Consecutive patients with an existing Watchman® left atrial appendage implant and symptomatic antiarrhythmic-drug refractory atrial fibrillation or atrial tachycardias requiring left atrial catheter ablation therapy were included. Open irrigated tip ablation and circular mapping catheters were positioned in the left atrium via double transseptal access. Ten patients underwent successful left atrial geometry creation and complex atrial arrhythmia mapping and ablation in the presence of a chronically implanted Watchman® device. Arrhythmia targets included left atrial flutters, a focal tachycardia, left atrial CFAE zones, and pulmonary vein electrical isolation. The appearances of the Watchman® device position and device integrity were confirmed to be satisfactory in all patients at the end of the procedure based on fluoroscopy and intracardiac echocardiography imaging. There were no procedural complications.

Conclusion Left atrial catheter ablation therapy in the presence of an implanted Watchman® left atrial appendage occlusion device was efficacious and uncomplicated in our small single centre experience.

/pdf/left-atrial-catheter-ablation-subsequent-to-watchman-left-lfs1tncs1n.pdf

Left atrial catheter ablation subsequent to Watchman® left atrial appendage device implantation: a single centre experience

Percutaneous approaches for retrieval of an embolized or malpositioned left atrial appendage closure device: A multicenter experience.

Left Atrial Appendage Closure for Stroke Prevention: Devices, Techniques, and Efficacy.

Appendacide! Alas, poor auricle….

A 78-year-old woman with permanent atrial fibrillation was referred to our institution for percutaneous left atrial appendage (LAA) occlusion. The patient had a high thromboembolic risk based on a CHA2DS2-VASc score of 8 and was on oral anticoagulant therapy with rivaroxaban at a dose of 20 mg/d. Because of major postural instability, the patient experienced recurrent falls with subsequent large and disabling superficial hematomas. The HAS-BLED score was 4. The procedure was performed under general anesthesia and with transesophageal echocardiogram guidance. After transseptal puncture, a 5-Fr multipurpose catheter was used to engage and inject the LAA. The maximal diameter of the ostium and the landing zone of the LAA were measured at 22 and 25 mm using transesophageal echocardiogram (Figure 1A) and at 22 and 21 mm using angiography (Figure 1B). Based on these measurements, we estimated an average diameter of the landing zone of 23 mm and we decided …

Delayed and Fatal Embolization of a Left Atrial Appendage Closure Device

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Delayed and Fatal Embolization of a Left Atrial Appendage Closure Device