Case Report
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World J Cardiol. Apr 26, 2014; 6(4): 213-215
Published online Apr 26, 2014. doi: 10.4330/wjc.v6.i4.213
Cardiac embolism after implantable cardiac defibrillator shock in non-anticoagulated atrial fibrillation: The role of left atrial appendage occlusion
Xavier Freixa, Rut Andrea, Victoria Martín-Yuste, Diego Fernández-Rodríguez, Salvatore Brugaletta, Mónica Masotti, Manel Sabaté
Xavier Freixa, Rut Andrea, Victoria Martín-Yuste, Diego Fernández-Rodríguez, Salvatore Brugaletta, Mónica Masotti, Manel Sabaté, Department of Interventional Cardiology, Thorax Institute, Hospital Clinic of Barcelona, University of Barcelona, 08036 Barcelona, Spain
Author contributions: Freixa X, Andrea R, Martín-Yuste V and Fernández-Rodríguez D contributed to the conception and design of the paper; Freixa X, Andrea R and Fernández-Rodríguez D drafted the article; Freixa X, Andrea R, Martín-Yuste V, Fernández-Rodríguez D, Brugaletta S, Masotti M and Sabaté M contributed to the final review and manuscript approval of the version to be published.
Correspondence to: Xavier Freixa, MD, Department of Interventional Cardiology, Thorax Institute, Hospital Clinic of Barcelona, University of Barcelona, c/Villarroel 170, 08036 Barcelona, Spain. xavierfreixa@hotmail.com
Telephone: +34-93-2275519 Fax: +34-93-2275505
Received: October 18, 2013
Revised: December 6, 2013
Accepted: February 18, 2014
Published online: April 26, 2014
Processing time: 188 Days and 0.7 Hours
Abstract

Cardioembolic events are one of the most feared complications in patients with non-valvular atrial fibrillation (NVAF) and a formal contraindication to oral anticoagulation (OAC). The present case report describes a case of massive peripheral embolism after an implantable cardiac defibrillator (ICD) shock in a patient with NVAF and a formal contraindication to OAC due to previous intracranial hemorrhage. In order to reduce the risk of future cardioembolic events, the patient underwent percutaneous left atrial appendage (LAA) occlusion. A 25 mm Amplatzer™ Amulet was implanted and the patient was discharged the following day without complications. The potential risk of thrombus dislodgement after an electrical shock in patients with NVAF and no anticoagulation constitutes a particular scenario that might be associated with an additional cardioembolic risk. Although LAA occlusion is a relatively new technique, its usage is rapidly expanding worldwide and constitutes a very valid alternative for patients with NVAF and a formal contraindication to OAC.

Keywords: Left atrial appendage; Implantable cardiac defibrillator; Defibrillator; Atrial fibrillation

Core tip: The present case report discusses the treatment of a patient with atrial fibrillation and contraindication to anticoagulation who presented with a massive peripheral embolism after an implantable cardiac defibrillator shock. The manuscript describes the successful management of the patient and discusses a clinical setting that might be associated with an increased cardioembolic risk.