Late Dehiscence of Left Atrial Appendage Closure Device

A 68-year-old male with history of hypertension, diabetes mellitus, and persistent atrial fibrillation (AF) refractory to amiodarone (CHA2DS2-VASc score of 3) underwent a successful total thoracoscopic surgical ablation of AF (mini-maze) procedure in August 2011. A transesophageal echocardiogram (TEE) performed before the procedure revealed no evidence of thrombus in the left atrial appendage (LAA). The base of the LAA measured 45 mm. The mini-maze procedure involved bilateral thoracoscopic, minimally invasive bilateral pulmonary vein antral isolation with bipolar radiofrequency, creation of roof and floor lines to isolate the posterior left atrium using bipolar radiofrequency, and exclusion of LAA with AtriCure Gillinov-Cosgrove clip of 45 mm size. Intraoperative TEE after clip deployment showed near-complete occlusion of the LAA. Dabigatran was discontinued after 3 months. A year later, patient was referred for electrophysiology study for symptomatic left-sided atrial tachycardia. A cardiac magnetic resonance imaging performed before the ablation revealed persistent occlusion of the LAA with the AtriClip with only a small portion of the proximal LAA remaining patent without any flow. All 4 pulmonary veins remained isolated from the previous ablation. An …