Bailout Double-Sheath Technique to Dilate the Interatrial Septum for Accidentally Pulled-Back Watchman Access Sheath

During percutaneous left atrial appendage closure using the Watchman device, the access sheath usually remains in the left atrium. We experienced a case in which we could not recapture the device, because the access sheath was accidentally pulled back to the right atrium. Because bailout from the access sheath was unsuccessful, balloon dilation of the interatrial septum was performed using a double-sheath technique via the contralateral femoral vein. Interatrial septum balloon dilation facilitates device traversal into the left atrium. Likewise, balloon dilation using a double-sheath technique is a safe and effective approach for managing such situations.