Late-Onset Pericardial Effusion and Device Extrusion After Left Atrial Appendage Occluder Implantation.

BACKGROUND

We present a case of Watchman device extrusion from left atrial appendage (LAA) free wall 6 months after implantation in a patient with longstanding persistent atrial fibrillation.

CASE SUMMARY: A 74-year-old male with longstanding persistent atrial fibrillation of 15 years duration was implanted with a Watchman device as he cannot be on long-term oral anticoagulation due to a history of multiple falls. Six months post implantation, repeat transesophageal echocardiogram revealed a thrombus on the epicardial aspect of LAA and a large posterior pericardial effusion. The patient subsequently underwent surgical removal of both the LAA and the protruding Watchman device.

DISCUSSION: In the case we present, the patient developed a clinically significant pericardial effusion 6 months after the Watchman device implantation, accompanied by left atrial extrusion, which was not reported to our knowledge.

TAKE-HOME MESSAGE: Complications of Watchman devices respect no timeline boundaries and should be kept in mind when evaluating cardiac tamponade in patients with an implanted Watchman device.