Left atrial appendage (LAA) clipping during open cardiac surgery is widely used for stroke and embolization prevention in atrial fibrillation. Various devices are available for this purpose, including the AtriCure AtriClip and the recently introduced Medtronic Penditure clip. We present a case of a 59-year-old male with multiple comorbidities, including chronic kidney disease and coronary artery disease, who underwent coronary artery bypass grafting with prophylactic LAA clipping using the Medtronic Penditure atrial clip. The procedure was complicated by an iatrogenic hematoma due to clip erosion into the atrioventricular groove, leading to left atrial tamponade and necessitating chest re-exploration. This case underscores the importance of understanding the structural interactions between different LAA occlusion devices and surrounding cardiac anatomy. Further evaluation is warranted to assess the safety profile of newer LAA occlusion devices and their impact on postoperative outcomes.
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http://dx.doi.org/10.14797/mdcvj.1534 | DOI Listing |
JACC Case Rep
January 2025
Division of Cardiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA. Electronic address:
Background: Although rare, embolization of left atrial appendage occlusion (LAAO) devices carries a significant morbidity and mortality burden.
Case Summary: An asymptomatic 77-year-old woman with inability to tolerate anticoagulation due to gastrointestinal bleeding presented for 45-day transesophageal echocardiography following LAAO with a Watchman device, which demonstrated incidental device migration to the left ventricular outflow tract (LVOT). Percutaneous extraction was performed using a novel technique with rat tooth/alligator forceps to successfully retrieve the Watchman from the LVOT using a transaortic approach.
Europace
March 2025
Cardiology Department, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, OX3 9DU, United Kingdom.
Background And Aims: Advanced technologies such as charge density mapping (CDM) show promise in guiding adjuvant ablation in patients with persistent atrial fibrillation (AF); however, their limited availability restricts widespread adoption. We sought to determine whether regions of the left atrium containing CDM-identified pivoting and rotational propagation patterns during AF could also be reliably identified using more conventional contact mapping techniques.
Methods: Twenty-two patients undergoing de novo ablation of persistent AF underwent both CDM and electroanatomic voltage mapping during AF and sinus rhythm with multiple pacing protocols.
Catheter Cardiovasc Interv
March 2025
Division of arrhythmology, San Raffaele Hospital, Milan, Italy.
Background: Performing a left atrial appendage occlusion (LAAO) or catheter ablation with left-sided intracardiac thrombus is considered very-high risk for periinterventional stroke. Cerebral embolic protection (CEP) devices are designed to prevent cardioembolic stroke and have been widely studied in TAVR procedures. However, their role in LAAO and catheter ablation of ventricular tachycardia (VT) or in pulmonary vein isolation (PVI) with cardiac thrombus present remains unknown.
View Article and Find Full Text PDFFront Cardiovasc Med
February 2025
Department of Radiology, Ningbo No.2 Hospital, Ningbo, China.
Radiofrequency ablation (RFA) is an important therapeutic modality for atrial fibrillation (AF), widely utilized in clinical practice due to its safety and significant efficacy. However, post-procedural complications may arise, influenced by anatomical positioning and the intensity of ablation energy, with atrioesophageal fistula (AEF) being particularly rare yet severe. This case report describes a unique instance of a patient developing AEF following AF ablation, accompanied by ischemic stroke and myocardial infarction.
View Article and Find Full Text PDFAm J Case Rep
March 2025
Department of Cardiology, St Vincent's Hospital Sydney, Sydney, New South Wales, Australia.
BACKGROUND Cardiomyopathy associated with thymoma is thought to be a cardiac manifestations of myasthenia gravis (MG). However, there are case reports of newly diagnosed thymoma presenting with cardiomyopathy without MG, and the mechanism remains unclear. The purpose of this report is to explore tachycardia-induced cardiomyopathy (TIC) as a potential mechanism for cardiomyopathy in thymoma without features of MG.
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