A case series of plug-based closure of peri-device leak after left atrial appendage occlusion

Peri-device leak (PDL) following left atrial appendage occlusion (LAAO) is particularly problematic in patients with both high thromboembolic and bleeding risk. We present a case series of three patients with atrial fibrillation and high bleeding risk. All three patients underwent LAAO with a Watchman™ and were found to have PDL on follow-up imaging. All three patients underwent successful PDL closure with an Amplatzer™ duct occluder II device with no complications noted. These cases demonstrate that PDL closure can be safely and effectively performed via a plug-based approach. Imaging is critical in determining candidacy for and method of PDL closure. • A plug-based approach can safely and effectively address PDL following LAAO. • Imaging is key in diagnosis, pre-procedural planning, and guiding successful closure. • Further study of device durability and long-term outcomes is needed.