Key result
Late S. aureus endocarditis on an Amplatzer Amulet device proves fatal without surgical extraction.
Why the study?
Left atrial appendage closure devices have been available for several years, but very few case reports of device-associated endocarditis have been reported.
Case Report (n=1)
No
This case highlights that infective endocarditis of a left atrial appendage closure device can occur late (20 months post-implantation) even after presumed complete endothelialization, requiring transoesophageal echocardiography for diagnosis.
Late LAA device endocarditis requires clinical vigilance; case reports leave open optimal surveillance protocols.
Background Due to advances in interventional cardiology in recent years, more and more patients are currently receiving cardiac devices, with a subsequent increase in the number of patients with device-associated endocarditis. Device-associated endocarditis is a life-threatening disease with special diagnostic and therapeutic challenges. Interventional devices for left atrial appendage (LAA) closure have been available for several years. However, there have been very few case reports of LAA closure device–associated endocarditis. Case summary An 83-year-old woman presented with fever and fatigue. She had a history of permanent atrial fibrillation and recurrent bleeding on oral anticoagulation. Consequently, the patient underwent interventional LAA closure ∼20 months earlier. Blood cultures grew Staphylococcus aureus. Transoesophageal echocardiography revealed an LAA closure device–associated mobile, echo-dense mass that was consistent with infectious vegetation in this clinical context. Intravenous antibiotic therapy was started, and our heart team recommended complete removal of the device, which the patient refused. The patient subsequently died as a result of progressive endocarditis and multiple pre-existing co-morbidities. Discussion Left atrial appendage occlusion device–associated endocarditis has rarely been reported. Due to the increase in LAA closure device implantation, device-associated endocarditis is expected to increase in the future. Transoesophageal echocardiography is required for correct diagnosis. Our case report suggests that an infection can occur long after implantation.
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Al‐Terki et al. (2022) conducted a case report in Left atrial appendage closure device-associated infective endocarditis (n=1). Intravenous flucloxacillin and rifampicin (patient refused surgical removal of the LAA closure device) was evaluated on Clinical resolution and survival. Staphylococcus aureus endocarditis on an Amplatzer Amulet LAA closure device occurred 20 months post-implantation in an 83-year-old woman, leading to death after she refused surgical device removal.
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