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

Abstract

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.

Catch of the day: interventional device retrieval after late embolization of an Amplatzer cardiac plug left atrial appendage occluder

“…Several possible complications have been reported after LAA closure such as pericardial effusion, free wall rupture and device thrombosis [3][4][5]. Device embolization is a known complication with an average reported rate of less than 4 % [6]. However, in a current meta-analysis late embolization of Amplatzer cardiac plug (ACP) was reported in 6 cases and were mainly clinically asymptomatic and detected during routine echocardiography [6].…”

Percutaneous Retrieval of Dislodged Left Atrial Appendage Occlusion Devices through the Transseptal Approach

“…[3][4][5] The potential mechanisms leading to device embolization include incorrect device apposition, device undersizing or excessive oversizing, shallow landing zone, vigorous tug test, and others. In particular, a morphologically early lobulated LAA can cause a relatively shallow landing zone for device implantation, which may contribute to device dislodgement.…”

“…3 Percutaneous retrieval of the embolized device in the LV is very challenging due to the substantial risk of damage to the aortic and mitral valves, even though a dislodged device is relatively stable in position. Stabilizing wires, especially in the unfolded state of the embolized device, may hook into surrounding structures, such as the mitral valve, causing tissue damage.…”

“…Device embolization is a known complication of LAA occlusion, with an average reported rate of <4%, 2 and surgical removal of the embolized LAA occlusion device increases procedure-associated morbidity and mortality. 3,4 Percutaneous retrieval of a dislodged device is safe but challenging, especially when the device is flitting in the left atrial (LA) cavity or entrapped in the apparatus of the left ventricle (LV). Moreover, relatively few studies describe techniques for retrieval of Authors Sang Yeub Lee and Jin-Seok Kim contributed equally to this study.…”

Role of Imaging in Left Atrial Appendage Occlusion

“…In a systematic review by Aminian et al, two-thirds of reported cases were acute, with 60% of those cases occurring during the procedure. Most cases were asymptomatic [55]. Device embolization may be diagnosed by fluoroscopy, chest X-ray, TTE, TOE or CCTA (Fig 7, panel C).…”