Key result
Delayed Watchman FLX embolization causes fatal complete mid-abdominal aortic occlusion 18 days post-implant.
Why the study?
Device embolization after left atrial appendage occlusion is rare and typically occurs intraprocedurally or within 24 hours, but delayed embolization risk stratification is inadequate.
Case Report (n=1)
This case illustrates a rare but fatal presentation of delayed LAAO device embolization, suggesting that current risk stratification protocols may be inadequate and that extended activity restrictions and earlier surveillance imaging warrant investigation for high-risk patients.
Late LAAO embolization may occur during exertion beyond 24 hours; leaves open optimal activity restrictions and surveillance duration.
BACKGROUND: Left atrial appendage occlusion (LAAO) is an established alternative to long-term anticoagulation for stroke prevention in select patients with atrial fibrillation. Device embolization is rare, most commonly occurring intraprocedurally or within 24 hours. CASE SUMMARY: A 67-year-old man with paroxysmal atrial fibrillation underwent successful implantation of a Watchman FLX device. Eighteen days later, while shoveling snow, he developed sudden-onset chest and back pain followed by bilateral lower extremity paralysis. Computed tomography revealed complete mid-abdominal aortic occlusion from embolization of the LAAO device. Despite emergent endovascular retrieval and restoration of aortic flow, the patient developed fatal distributive shock from severe ischemia-reperfusion injury. DISCUSSION: This case illustrates a rare but clinically significant presentation of delayed device embolization. This patient possessed multiple National Cardiovascular Data Registry-identified risk factors for postdischarge device embolization, indicating that current risk stratification protocols may not be adequate for patients with device embolization risk factors. TAKE-HOME MESSAGES: Risk-stratified protocols with extended activity restrictions and earlier postprocedure surveillance imaging warrant investigation in patients with National Cardiovascular Data Registry-identified risk factors for postdischarge LAAO device embolization.
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Mackey et al. (2026) conducted a case report in Paroxysmal atrial fibrillation (n=1). Left atrial appendage occlusion (Watchman FLX device) was evaluated on Delayed device embolization. A 67-year-old man developed fatal complete mid-abdominal aortic occlusion due to delayed embolization of a Watchman FLX device 18 days post-implantation.
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