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Case Reports
. 2024 Jun 29;16(6):e63442.
doi: 10.7759/cureus.63442. eCollection 2024 Jun.

Unforeseen and Immediate: A Case of a Post-Watchman Device-Related Thrombus

Samdish Sethi  1 , Anton Stolear  1 , Maxim Dulgher  2 , Nneka Nwokeocha  1 , Victor Mejia  1 , Evgeny Shkolnik  3
Affiliations
Case Reports

Unforeseen and Immediate: A Case of a Post-Watchman Device-Related Thrombus

Samdish Sethi et al. Cureus. .

Abstract

Atrial fibrillation (AFib) is recognized as a risk factor linked to arterial thromboembolism stemming from blood clot formation in the left atrium, associated with increased morbidity and mortality. Most of these thrombi originate in the left atrial appendage (LAA). Oral anticoagulation (OAC) therapy can help mitigate this risk. LAA occlusion (LAAO) has emerged as an option for patients who cannot safely tolerate long-term OAC. Watchman is one of the commonly used devices with a favorable safety profile demonstrated in numerous studies. One of the most concerning complications of LAAO is device-related thrombus (DRT), which may form on the atrial side of the device and potentially lead to embolization. We present a rare case of immediate DRT formation following the deployment of a Watchman device in a 78-year-old male with persistent AFib. Despite appropriate periprocedural management, a thrombus was observed immediately post implantation. This case emphasizes the need for vigilant surveillance, prompt diagnosis, and therapeutic intervention to manage such complications. The patient was successfully managed with a heparin drip, leading to thrombus resolution. This report underscores the complexities of managing DRT and the importance of ongoing research to optimize outcomes for patients undergoing LAAO.

Keywords: anticoagulation; atrial fibrillation; device-related thrombus; left atrial appendage occlusion; watchman.

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Conflict of interest statement

Human subjects: Consent was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.

Figures

Figure 1
Figure 1. Mobile linear thrombus measuring up to 3.5 cm (white arrow) was observed at a core wire attachment site of the Watchman device (blue arrow) visualized on TEE.
Mid-esophageal biplane views at 0° (A) and 80° (B) focusing on the mobile thrombus.
Figure 2
Figure 2. 3D TEE (A and B) of mobile thrombus (white arrow) attached to the Watchman device (blue arrow).
Figure 3
Figure 3. Resolution of a previously seen mobile thrombus on follow-up TEE three days later. Watchman device indicated by the blue arrow.
Mid-esophageal views at 75° (A) and 0° (B) focusing on the Watchman device at the attachment site of the previously seen thrombus.
See this image and copyright information in PMC

References

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