Left Atrial Appendage Occlusion and Percutaneous Coumadin Ridge Mass Exclusion: Two Targets, One Device.

Authors

Alexander Ottersbach, Adam Bisharat, Dimitri Sherev, Nassir A Azimi

Published in

JACC. Case reports. Pages 111087. Nov 12, 2026. Epub Nov 12, 2026.

Abstract

Mobile cardiac masses on the coumadin ridge are rare and carry significant embolic risk, compounded by concurrent atrial fibrillation. Surgical excision may be prohibitive in patients with high bleeding risk.
A 70-year-old man with paroxysmal atrial fibrillation, a HAS-BLED score of 4, and aversion to anticoagulation was referred for left atrial appendage (LAA) closure. Imaging revealed an incidental 0.56-cm mobile coumadin ridge mass consistent with papillary fibroelastoma. The Amplatzer Amulet was selected for its larger disc geometry to simultaneously occlude the LAA and exclude the mass, with follow-up confirming complete mass exclusion and stability at over 2 years.
This is to our knowledge the first reported case of intentional simultaneous LAA occlusion and percutaneous mass exclusion, demonstrating a novel use of device geometry to manage dual embolic risk.
Concurrent LAA and coumadin ridge mass risk can be addressed in a single procedure through deliberate device selection using the Amulet's larger disc.

PMID:
43018522
Bibliographic data and abstract were imported from PubMed on 12 Nov 2026.

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