Management of device embolisation during left atrial appendage closure.

Abstract

Percutaneous left atrial appendage closure (LAAC) is increasingly used as a valuable intervention to prevent cardioembolic stroke among patients with atrial fibrillation who are poor candidates for long-term anticoagulation. The safety of the procedure has significantly improved over time; nevertheless, device embolisation remains a severe complication that still occurs in around 0.1% of cases. Its management must be rapid and effective in order to reduce mortality. The anatomical location of the embolised device dictates the technical approach for retrieval and has a major impact on the clinical outcome of patients. Percutaneous recapture is the main approach in case of an aortic or left atrial embolisation, while emergent surgery should be performed if the device becomes entangled in the mitral apparatus with poor haemodynamics unsolved by transcatheter device mobilisation into the left ventricular (LV) cavity. In cases of LV embolisation and stable haemodynamics, a transfemoral or transseptal retrieval may be attempted. The equipment for retrieval is key to success: all cath labs performing LAAC procedures should be equipped with minimum 16 Fr sheaths, steerable sheaths, single-loop snares and grasping tool devices. This paper includes a summary of the European Left Atrial Appendage Closure Club consensus recommendations for LAAC device embolisation management.