Introduction
Left atrial appendage (LAA) occlusion with the Watchman device (Boston
Scientific, Marlborough, MA) is increasingly being used as an
alternative for stroke prevention in patients with non-valvular atrial
fibrillation (AF) at high risk of complications from long term
anticoagulation (1). Although the procedure has an overall favorable
safety profile, it does carry a small risk of serious complications.
Compared to the initial PROTECT AF trial, the subsequent PREVAIL trial
demonstrated a reduction in the incidence of procedural complications
from 8.7% to 4.2%. In particular, post-procedural pericardial
effusions requiring pericardiocentesis or surgery were significantly
reduced, with only one reported case of cardiac perforation among 269
patients in the device group (1). Here we report a case of left atrial
appendage perforation resulting from Watchman device deployment
requiring emergency repair of the left atrium using sternotomy and
cardiopulmonary bypass and discuss options for surgical management of
this complication. Informed consent was waived by Institutional Review
Board.