What is the clinical evidence from this study?

Study design: Case Report. Population: Atrial fibrillation with residual leak after surgical LAA ligation (n=1). Intervention: Percutaneous closure using Amplatzer Amulet device. Primary outcome: Successful leak elimination.

What does this research mean for the field?

Percutaneous closure using an Amplatzer Amulet device successfully eliminates residual left atrial appendage leaks and prevents recurrent stroke, offering a viable alternative to repeat surgery in high-risk atrial fibrillation patients. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

What question did this study set out to answer?

To describe the catheter-based management of a significant residual left atrial appendage leak in a patient who experienced an ischemic stroke despite anticoagulation after surgical ligation.

March 8, 2026BMC Cardiovascular DisordersOpen Access

Percutaneous closure of residual leak after surgical left atrial appendage ligation: a case of stroke prevention in high-risk atrial fibrillation

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Key result

Percutaneous Amplatzer Amulet closure successfully eliminates a residual LAA leak in a high-risk AF patient.

Why the study?

Incomplete surgical LAA closure is associated with increased thromboembolic risk in atrial fibrillation patients.

Key Points

To describe the catheter-based management of a significant residual left atrial appendage leak in a patient who experienced an ischemic stroke despite anticoagulation after surgical ligation.
Evaluated a 64-year-old female with atrial fibrillation (CHA₂DS₂-VASc score 4) presenting with ischemic stroke on anticoagulation following previous surgical left atrial appendage ligation.
Identified a 10 mm residual communication using transesophageal echocardiography.
Executed percutaneous defect closure utilizing a 31 mm Amplatzer Amulet device based on landing zone dimensions within the native appendage structure.
Achieved successful elimination of the 10 mm residual leak using the dual-seal Amplatzer Amulet device.
Initiated postoperative antithrombotic management comprising apixaban and aspirin for 3-6 months followed by indefinite apixaban monotherapy.

Study Design

Type

Case Report (n=1)

Multicenter

Structured PICO

Population

A 64-year-old female with high-risk atrial fibrillation and a history of ischemic stroke despite anticoagulation who underwent percutaneous closure of a 10 mm residual leak following incomplete surgical LAA ligation.

Intervention

Percutaneous closure of a 10 mm residual LAA leak using a 31 mm Amplatzer Amulet device, followed by apixaban 5 mg BID and aspirin 81 mg daily.

Outcome

Successful leak elimination assessed by transesophageal echocardiography at 2 months.surrogate

Percutaneous closure of residual leaks following incomplete surgical LAA closure is a viable and effective alternative to repeat surgery in high-risk patients with recurrent stroke.

Limitations

Evidence comes primarily from case series and observational studies
Lack of randomized controlled trials comparing different management strategies for this specific clinical scenario
Lack of evidence-based guidelines for antithrombotic therapy following percutaneous closure of post-surgical LAA leaks

Implication

Supports percutaneous closure as less invasive alternative to repeat surgery in high-risk AF with residual LAA leak; hypothesis-generating and should not yet change practice.

Abstract

Incomplete surgical left atrial appendage (LAA) closure is associated with increased thromboembolic risk in atrial fibrillation patients. We present a case of successful percutaneous closure of a significant residual leak following surgical LAA ligation. A 64-year-old female with atrial fibrillation (CHA₂DS₂-VASc score 4), prior surgical interventions including LAA ligation for thrombus formation, presented with ischemic stroke despite anticoagulation. Transesophageal echocardiography revealed a 10 mm residual communication following incomplete LAA closure. Percutaneous closure was performed using a 31 mm Amplatzer Amulet device with successful leak elimination. Percutaneous closure of residual leaks following incomplete surgical LAA closure represents a viable alternative to repeat surgery in high-risk patients. Individualized antithrombotic therapy is essential for optimal outcomes.

Discussion

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Figures from the paper

Published by BMC Cardiovascular Disorders · CC BY

Cite This Study

Doğan et al. (2026) conducted a case report in Atrial fibrillation with residual leak after surgical LAA ligation (n=1). Percutaneous closure using Amplatzer Amulet device was evaluated on Successful leak elimination. Percutaneous closure using a 31 mm Amplatzer Amulet device successfully eliminated a 10 mm residual leak following incomplete surgical left atrial appendage ligation in a high-risk patient.

synapsesocial.com/papers/69ad12afe7e9681137aa8a34 https://doi.org/10.1186/s12872-026-05689-w

Topics

Left atrial appendage closure

Atrial fibrillation

Persistent AF management

Anticoagulation in AF

AF ablation outcomes

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Implication

Supports percutaneous closure as less invasive alternative to repeat surgery in high-risk AF with residual LAA leak; hypothesis-generating and should not yet change practice.

Percutaneous closure of residual leak after surgical left atrial appendage ligation: a case of stroke prevention in high-risk atrial fibrillation

Key Points

Study Design

Structured PICO

Limitations

Implication

Abstract

Discussion

Figures from the paper

Cite This Study

Topics

Percutaneous closure of residual leak after surgical left atrial appendage ligation: a case of stroke prevention in high-risk atrial fibrillation

Key Points

Study Design

Structured PICO

Limitations

Implication

Abstract

Discussion

Figures from the paper

Cite This Study

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