Incidental Aorto-Atrial Fistula Complicating a Watchman Implantation Procedure

An aorto-atrial fistula (AAF) is a rare and often fatal condition involving abnormal blood flow between the aorta and an atrium.A 65-year-old male undergoing a Watchman procedure was found to have an aorto-left atrial appendage (LAA) fistula during angiography later confirmed by chest CT.The patient had recent acute decompensated heart failure (ADHF) but no risk factors.Successful treatment involved arterial coiling of the fistula before Watchman device implantation.AAFs are best detected using transesophageal echocardiography (TEE) or angiography, with TEE being more sensitive than transthoracic echocardiography.Early diagnosis and treatment are crucial for reducing morbidity and mortality.