Percutaneous Rescue With Sequential Second-Device Usage for Left Atrial Appendage Perforation During Amulet Implantation.

BACKGROUND

Left atrial appendage closure (LAAC) prevents stroke in nonvalvular atrial fibrillation, while device-related left atrial appendage (LAA) perforation may lead to cardiac tamponade.

CASE SUMMARY: A man in his early 80s underwent percutaneous LAAC using the Amulet device. During deployment, sustained counterclockwise torque in a ball-shaped configuration resulted in perforation of the LAA, with device extrusion and progressive pericardial effusion. To avoid bleeding upon extraction, we executed a sequential second-device rescue: The first device was left in situ to tamponade the defect, while a downsized Amulet was positioned at the orifice; the first device was then withdrawn, and the second device was released immediately, sealing the LAA. Ultimately, the patient was discharged uneventfully.

DISCUSSION: Sheath rotation in a ball configuration is generally considered safe, while excessive torque can make this maneuver risky.

TAKE-HOME MESSAGE: LAAC itself can treat acute perforation by sealing both the defect and the LAA before considering surgery.