Late Coronary-cameral Fistula Formation Between Circumflex Coronary Artery and Left Atrial Appendage Following Implantation of an Amulet Closure Device

An 80-year-old patient presented with a rare complication: a late coronary-cameral fistula following implantation of an Amulet (Abbott) left atrial appendage occlusion device. Microperforations from the device's anchoring tines have previously been suggested as a possible mechanism of fistula formation, a complication reported in two other cases. We propose an alternative theory of potential collateralisation of the threatened appendage from the nearby circumflex artery.