Delayed and Fatal Embolization of a Left Atrial Appendage Closure Device

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 …