Spontaneous occlusion of the left atrial appendage before percutaneous left atrial appendage occlusion

Excerpt

A 67-year-old man with a history of atrial fibrillation (AF) and higher bleeding risk (HAS-BLED score 3 pts) was referred to our institution for the treatment of percutaneous left atrial appendage occlusion (LAAO). He has been treated AF for 16 years. His medications included well-controlled warfarin (CHA₂DS₂-VASc score 3 pts) and he had no history of stroke or systemic embolization. At the time of diagnosis of AF, transesophageal echocardiography (TEE) was performed before cardioversion. There was no thrombus or unusual anatomy of the LAA. He subsequently underwent cardioversion, which was unsuccessful; therefore, he was prescribed an oral anticoagulation drug. LAAO was planned based on the discussion of our heart-team. Cardiac computed tomography (cCT) and TEE were performed as preprocedural evaluations for the intervention. Nonetheless, his LAA was not visualized on TEE (Fig. 1A–D). The LAA was spontaneously filled with thrombus, and its orifice was covered by smooth tissues (Fig. 1A–D). Furthermore, cCT revealed signs of an occluded LAA, similar to TEE findings (Fig. 1E–F). The thrombophilia screening results were negative. Thus, we considered that the risk of AF-mediated ischemic stroke or systemic embolism had been already eliminated and that LAAO was unsuitable for the patient. The oral anticoagulation drug was discontinued based on the salient multimodality imaging findings. Remarkably, no thromboembolic events occurred at 6 month follow-up.

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