Case Report
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World J Cardiol. Oct 26, 2013; 5(10): 391-393
Published online Oct 26, 2013. doi: 10.4330/wjc.v5.i10.391
Medical management of connector pin thrombosis with the Amplatzer cardiac plug left atrial closure device
Diego Fernández-Rodríguez, Luca Vannini, Victoria Martín-Yuste, Salvatore Brugaletta, Rocío Robles, Ander Regueiro, Mónica Masotti, Manel Sabaté
Diego Fernández-Rodríguez, Luca Vannini, Victoria Martín-Yuste, Salvatore Brugaletta, Rocío Robles, Ander Regueiro, Mónica Masotti, Manel Sabaté, Department of Cardiology, Thorax Institute, Hospital Clínic, University of Barcelona, IDIBAPS, 08036 Barcelona, Spain
Author contributions: All authors contributed to the redaction of this manuscript.
Correspondence to: Victoria Martín-Yuste, MD, PhD, Department of Cardiology, Thorax Institute, Hospital Clínic, University of Barcelona, IDIBAPS, C/Villarroel 170, 08036 Barcelona, Spain. vmartiny@clinic.ub.es
Telephone: +34-934-2275519 Fax: +34-934-2275751
Received: May 26, 2013
Revised: September 9, 2013
Accepted: September 18, 2013
Published online: October 26, 2013
Processing time: 151 Days and 15.3 Hours
Abstract

Transcatheter closure of the left atrial appendage with the Amplatzer™ cardiac plug device and double antiplatelet treatment for 3 mo has become an alternative treatment for patients with atrial fibrillation at high embolism risk and contraindications for chronic oral anticoagulation. The inadequate implantation of the left atrial appendage closure device and the discontinuation of double antiplatelet therapy are well-known as factors related to device thrombosis. Nevertheless, device thrombosis after adequate implantation requiring surgical treatment or restarting chronic oral anticoagulation has been reported and can reach 15% of patients. The connector pin thrombosis of the Amplatzer™ cardiac plug, despite a good adherence to antiplatelet treatment, has been recently described as a potential mechanism for device thrombosis. Our clinical case reports the management of this condition for the first time, showing that the early detection of thrombotic complications by transesophageal echocardiography permits solving this serious complication with medical treatment only.

Keywords: Atrial fibrillation; Oral anticoagulation; Left atrial appendage closure; Amplatzer cardiac plug; Device thrombosis

Core tip: Percutaneous closure of the left atrial appendage has become an alternative treatment for patients with atrial fibrillation and with contraindications for chronic oral anticoagulation. Recently, the first case of connector pin thrombosis of the Amplatzer™ cardiac plug device for percutaneous left atrial appendage closure was described. Our work describes the management of this serious problem for the first time.