Key result
TEE detects late Watchman device infection in persistent MRSA bacteremia after negative transthoracic imaging.
Why the study?
Device-related infection of left atrial appendage occlusion devices is a rare complication that typically occurs early after implantation, with limited data on late infections.
Case Report (n=1)
In patients with left atrial appendage occlusion devices and persistent bacteremia, transesophageal echocardiography is critical for diagnosing rare late device infections when transthoracic imaging is unremarkable.
May prompt TEE in persistent bacteremia with LAAO devices after negative TTE; leaves open prospective data on late infection incidence and outcomes.
BACKGROUND: Left atrial appendage occlusion devices are used for stroke prevention in patients with atrial fibrillation who cannot tolerate long-term anticoagulation. Device-related infection is a rare complication and typically occurs early after implantation. CASE SUMMARY: A 73-year-old woman with paroxysmal atrial fibrillation who underwent Watchman implantation 6 years earlier presented with persistent methicillin-resistant Staphylococcus aureus bacteremia following debridement of infected right humeral hardware. Transthoracic echocardiography demonstrated preserved left ventricular systolic function without valvular abnormalities. Because of ongoing bacteremia, transesophageal echocardiography was performed that revealed a large mobile echodensity attached to the Watchman device, consistent with device infection. Surgical removal was not pursued because of prohibitive operative risk. DISCUSSION: This case illustrates a rare instance of Watchman infection from hematogenous seeding and highlights the critical diagnostic role of transesophageal echocardiography. TAKE-HOME MESSAGE: Persistent bacteremia in patients with left atrial appendage occlusion devices should prompt evaluation with transesophageal echocardiography for exclusion of device infection as demonstrated in this case.
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Kallur et al. (2026) conducted a case report in Left atrial appendage occlusion device infection (n=1). Transesophageal echocardiography vs. Transthoracic echocardiography was evaluated. Transesophageal echocardiography successfully identified a late Watchman device infection in a patient with persistent MRSA bacteremia after transthoracic imaging was unrevealing.
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