Cardiac embolism after implantable cardiac defibrillator shock in non-anticoagulated atrial fibrillation: The role of left atrial appendage occlusion.
Cardioembolic events are one of the most feared complications in patients with non-valvular atrial fibrillation (NVAF) and a formal contraindication to oral anticoagulation (OAC). The present case report describes a case of massive peripheral embolism after an implantable cardiac defibrillator (ICD) shock in a patient with NVAF and a formal contraindication to OAC due to previous intracranial hemorrhage. In order to reduce the risk of future cardioembolic events, the patient underwent percutaneous left atrial appendage (LAA) occlusion. A 25 mm Amplatzer™ Amulet was implanted and the patient was discharged the following day without complications. The potential risk of thrombus dislodgement after an electrical shock in patients with NVAF and no anticoagulation constitutes a particular scenario that might be associated with an additional cardioembolic risk. Although LAA occlusion is a relatively new technique, its usage is rapidly expanding worldwide and constitutes a very valid alternative for patients with NVAF and a formal contraindication to OAC.
Xavier Freixa, Rut Andrea, Victoria Martín-Yuste, Diego Fernández-Rodríguez, Salvatore Brugaletta, Mónica Masotti, Manel Sabaté, Department of Interventional Cardiology, Thorax Institute, Hospital Clinic of Barcelona, University of Barcelona, 08036 Barcelona, Spain.
Xavier
X
Freixa
Xavier Freixa, Rut Andrea, Victoria Martín-Yuste, Diego Fernández-Rodríguez, Salvatore Brugaletta, Mónica Masotti, Manel Sabaté, Department of Interventional Cardiology, Thorax Institute, Hospital Clinic of Barcelona, University of Barcelona, 08036 Barcelona, Spain.
Rut
R
Andrea
Xavier Freixa, Rut Andrea, Victoria Martín-Yuste, Diego Fernández-Rodríguez, Salvatore Brugaletta, Mónica Masotti, Manel Sabaté, Department of Interventional Cardiology, Thorax Institute, Hospital Clinic of Barcelona, University of Barcelona, 08036 Barcelona, Spain.
Victoria
V
Martín-Yuste
Xavier Freixa, Rut Andrea, Victoria Martín-Yuste, Diego Fernández-Rodríguez, Salvatore Brugaletta, Mónica Masotti, Manel Sabaté, Department of Interventional Cardiology, Thorax Institute, Hospital Clinic of Barcelona, University of Barcelona, 08036 Barcelona, Spain.
Diego
D
Fernández-Rodríguez
Xavier Freixa, Rut Andrea, Victoria Martín-Yuste, Diego Fernández-Rodríguez, Salvatore Brugaletta, Mónica Masotti, Manel Sabaté, Department of Interventional Cardiology, Thorax Institute, Hospital Clinic of Barcelona, University of Barcelona, 08036 Barcelona, Spain.
Salvatore
S
Brugaletta
Xavier Freixa, Rut Andrea, Victoria Martín-Yuste, Diego Fernández-Rodríguez, Salvatore Brugaletta, Mónica Masotti, Manel Sabaté, Department of Interventional Cardiology, Thorax Institute, Hospital Clinic of Barcelona, University of Barcelona, 08036 Barcelona, Spain.
Mónica
M
Masotti
Xavier Freixa, Rut Andrea, Victoria Martín-Yuste, Diego Fernández-Rodríguez, Salvatore Brugaletta, Mónica Masotti, Manel Sabaté, Department of Interventional Cardiology, Thorax Institute, Hospital Clinic of Barcelona, University of Barcelona, 08036 Barcelona, Spain.
Manel
M
Sabaté
Atrial fibrillation; Defibrillator; Implantable cardiac defibrillator; Left atrial appendage