Authors
Ryan J Mackey, Alec Miller, Leonard Palatnic, Sina Salehi Omran, Stanley F Fernandez, Vijay S Iyer, Mohamed Y Abdel-Aal Ahmed
Published in
JACC. Case reports. Pages 109756. Aug 12, 2026. Epub Aug 12, 2026.
Abstract
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.
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.
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.
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.
PMID:
42593374
Bibliographic data and abstract were imported from PubMed on 13 Aug 2026.
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