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• W4387249861 abstract "SESSION TITLE: Cardiovascular Disease Case Report Posters 17 SESSION TYPE: Case Report Posters PRESENTED ON: 10/09/2023 12:00 pm - 12:45 pm INTRODUCTION: Watchman device implantation is a minimally invasive procedure that is utilized for closure of left atrial appendage in patients with atrial fibrillation to prevent the risk of stroke. It has a high success rate with few complications reported. We present a unique case when catheter delivery during Watchman implantation was associated with acute thrombus formation despite prior anticoagulation and adequate heparinization. CASE PRESENTATION: A 79-year-old female with a past medical history of paroxysmal atrial fibrillation presented to the hospital for an elective WATCHMAN procedure. She could not tolerate anticoagulation due to gastrointestinal bleeding from recently diagnosed gastric arteriovenous malformations and was referred for the procedure. She was hemodynamically stable, and physical examination was unremarkable. Pre-operative transesophageal echocardiogram (TEE) was unremarkable for any intra-cardiac thrombus or vegetation. A heparin bolus was given to keep activated clotting time (ACT) over 300 seconds. Right femoral vein access was obtained and using a Brockenbrough needle, a transseptal puncture was performed under TEE and fluoroscopy guidance. As the catheter was advanced into the left atrium, a mobile mass was evident on TEE, confirming a new thrombus in the right atrium (RA) attached to the catheter. Immediately, the catheter was exchanged, and the intravenous heparin dose was increased. Repeat TEE was unremarkable following which, a 24 mm WATCHMAN device was successfully implanted. The patient received 6 weeks of anticoagulation, and a follow-up TEE after 6 weeks was again unremarkable for any RA thrombus. DISCUSSION: The WATCHMAN procedure has a high success rate of 98% with very few complications [1]. This is the second case reporting spontaneous intra-atrial thrombus formation on catheter delivery during WATCHMAN implantation. The delivery catheter is a foreign body that leads to the activation of a coagulation cascade resulting in thrombus formation[2]. Close monitoring of anticoagulation therapy during the procedure is key to prevent thrombosis. Immediate catheter exchange or thrombus removal with the AngioVac system serves as the best treatment[3]. CONCLUSIONS: Watchman's procedure can be associated with spontaneous right atrial thrombus formation on catheter delivery despite adequate heparinization. Management includes immediate catheter exchange or thrombus removal with the AngioVac system. REFERENCE #1: Reddy VY, Gibson DN, Kar S, O'Neill W, Doshi SK, Horton RP, Buchbinder M, Gordon NT, Holmes DR. Post-Approval U.S. Experience With Left Atrial Appendage Closure for Stroke Prevention in Atrial Fibrillation. J Am Coll Cardiol. 2017 Jan 24;69(3):253-261. doi: 10.1016/j.jacc.2016.10.010. Epub 2016 Nov 2. PMID: 27816552. REFERENCE #2: Dudiy Y, Kronzon I, Cohen HA, Ruiz CE. Vacuum thrombectomy of large right atrial thrombus. Catheterization and Cardiovascular Interventions. 2012 Feb 1;79(2):344-7. REFERENCE #3: Patel H, Castellanos LR, Golts E, Reeves R, Mahmud E, Hsu JC. Spontaneous Left Atrial Thrombus Formation on the Catheter Delivery System During WATCHMAN Implantation. Case Reports. 2020 Mar 1;2(3):444-8. DISCLOSURES: No relevant relationships by Omar Al Wahadneh No relevant relationships by OSAMA ALSARA No relevant relationships by Seemab Imtiaz Gill No relevant relationships by Mobeen Haider No relevant relationships by Muhammad Hasib Khalil No relevant relationships by Saad Ur Rahman" @default.
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• W4387249861 date "2023-10-01" @default.
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• W4387249861 title "A RARE COMPLICATION: SPONTANEOUS RIGHT ATRIAL THROMBUS ON CATHETER DELIVERY DURING WATCHMAN IMPLANTATION" @default.
• W4387249861 doi "https://doi.org/10.1016/j.chest.2023.07.408" @default.
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