Thoracoscopic left atrial appendage clipping as novel treatment option for peri-device leakage

A 69-year-old woman known with symptomatic antiarrhythmic drug refractory paroxysmal atrial fibrillation (AF), stroke (CHA2DS2-VASc score 5), and therapy-resistant epilepsy resulting in collapses with risk for head trauma (HAS-BLED score 3), underwent catheter ablation and transcatheter left atrial appendage (LAA) occlusion (WATCHMANTM 24 mm, Boston Scientific, Natick, MA, USA). Computed tomography (CT) scan revealed significant peri-device leakage (4–5 mm). Due to the absolute contra-indication for oral anticoagulation therapy, the patient was referred for thoracoscopic LAA-clipping (Atriclip PRO 145, AtriCure Inc., Dayton, OH, USA). Additionally, a totally thoracoscopic MAZE procedure (TT-MAZE) was performed. Perioperative Transesophageal echocardiography (TEE) showed complete closure of the LAA, which was confirmed on CT-scan performed 2 months after surgery. A 77-year-old male with a history of permanent AF (CHA2DS2-VASc score 4), prostate carcinoma, and gastro-intestinal bleedings (HAS-BLED score 3), underwent a WATCHMAN LAA occlusion (24 mm). Computed tomography scan revealed significant peri-device leakage (9 mm). The patient was referred for thoracoscopic LAA-clipping (Atriclip PRO 150). Additionally, a TT-MAZE was performed. Post-operative CT scan showed complete closure of the LAA as shown in Figure (the WATCHMAN (black arrow) and Atriclip (white arrow) are both in situ with no contrast in the LAA). Thoracoscopic LAA-clipping seems to be a feasible treatment option for peri-device leakage after incomplete transcatheter LAA-closure. The full-length version of this report can be viewed at: http://www.escardio.org/Guidelines-&-Education/E-learning/Clinical-cases/Electrophysiology/EP-Case-Reports.