Introduction
Atrial fibrillation (AF) is the most common sustained arrhythmia and is
associated with an ischemic stroke risk which is mitigated by
anticoagulation. In patients that are not suitable anticoagulation
candidates, closure of the left atrial appendage (LAA) is an alternative
to reduce the risk of thromboembolic stroke or systemic
thromboembolism.[1, 2] In patients with a history of AF undergoing
cardiac surgery, the LAA is often either ligated or amputated at the
time of surgery, however the rates of incomplete surgical LAA ligation
(ISLL) are high,[3, 4] and ISLL is associated with elevated risk of
thrombus formation and thromboembolism, likely due to constriction of
blood flow into the LAA.[5] In other patients with elevated risk of
thromboembolism from AF, endovascular closure of the LAA is often
attempted. This approach has been shown to be superior to warfarin for
the end point of stroke, systemic embolism, and cardiovascular death, as
well as all-cause mortality.[6] However, residual communications
between the LA and the LAA are relatively common. While small
communications have been shown not to be associated with elevated
thromboembolic risk,[7] leaks >5 mm typically require
treatment. In this case series, we report 5 consecutive cases of
residual communication between the LAA and the LA which were closed by
endovascular techniques.