Spontaneous Device Detachment After Its Partial Deployment During Left Atrial Appendage Occlusion: A Nightmare in the Cath Lab

J INVASIVE CARDIOL 2020;32(6):E177.

Key words: complications, device detachment, percutaneous left atrial appendage occlusion

A 76-year-old patient was scheduled for percutaneous left atrial appendage (LAA) occlusion after a hemorrhagic stroke. After transseptal puncture and LAA sizing guided by transesophageal echocardiography, we planned to implant a 25 mm Amplatzer Amulet (St. Jude Medical) through a 14 Fr delivery sheath (DS). During the device advancement maneuver, fluoroscopy demonstrated the spontaneous unscrewing of the device from the delivery cable (DC) inside the DS at the level of its first bend; meanwhile, the lobe was already partially expanded in the LAA (Figure 1A). We unsuccessfully attempted to rescrew the device to the DC in the same position. Since the DS had an optimal position within the LAA, the most appropriate option was to push the device distally to complete the deployment (Video 1). At this point, with the proximal edge of the device now at the level of the straight tract of the DS between the two 45° bends, we gained coaxiality to successfully rescrew the device to the DC (Figure 1B). After the tug test, final device deployment was completed with an optimal result (Figures 1C and 1D; Videos 2 and 3).   

To date, this is the first description of a spontaneous unscrewing of an Amplatzer Amulet device from its DC while its lobe was partially deployed within the LAA. In such cases, the device should be pushed forward to complete the deployment and to rescrew the device to the DC in order to prevent an unavoidable cardiac surgery. 

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From Clinical and Interventional Cardiology, Sassari University Hospital, Sassari, Italy.

Disclosure: The authors have completed and returned the ICMJE Form for Disclosure of Potential Conflicts of Interest. The authors report no conflicts of interest regarding the content herein. 

The authors report that patient consent was provided for publication of the images used herein.

Manuscript accepted October 7, 2019.

Address for correspondence: Giuseppe Talanas, MD, Clinical and Interventional Cardiology, Sassari University Hospital, Via Enrico De Nicola 14, 07100 Sassari, Italy. Email: giuseppe.talanas@aousassari.it