Significant Left Atrial Appendage Leak After LAA Exclusion System Occluded by ASD Closure Device.

BACKGROUND

Incomplete left atrial appendage (LAA) closure ("leak") is a challenge of LAA occlusive techniques and carries thromboembolic risk. Closure of significant leaks after surgical AtriClip is rare and less described.

CASE SUMMARY: An 81-year-old man with atrial fibrillation on apixaban, prior LAA AtriClip (2023), and multiple recent falls underwent transesophageal echocardiography that showed a residual severe central LAA ostium. Percutaneous ostia closure was performed using an atrial septal defect (ASD) plug via transseptal puncture approach. Residual flow ceased in the LAA, and anticoagulation was halted and transitioned to clopidogrel on discharge.

DISCUSSION: Approach to LAA leak closure is guided by size and morphology of the leak. In significant central leak, ASD occluders show superiority in long-term occlusion vs other methods.

TAKE-HOME MESSAGE: Closure with ASD occluders is a promising long-term solution for significant LAA leak after AtriClip, and intervention requires extensive multimodal imaging.