Clinical & Medical Case Reports in Cardiology

The risk of cardioembolic stroke is high in patients with atrial fibrillation. Antiplatelet agents, vitamin K antagonists and new oral anticoagulants (NOACS) are effectively used to reduce the risk of thromboembolism in high-risk patients. However, increased risks of life-threatening bleeding and narrow therapeutic indexes result in inadequate utilization of these therapies. There is growing practice and shreds of evidence in favor of closing left atrial appendage (LAA) percutaneously, using different devices in patients with either contraindicated or difficult anticoagulation. We are reporting a rare case of an old male with atrial fibrillation, high thromboembolic risk (CHADSVASc sore 4) and high bleeding risk score (HASBLED score 4). He underwent LAA closure using two LAA percutaneous closure devices (WATCHMAN) due to bi-lobed LAA. Considering a great variability in the shape and size of LAA, sometimes, a single device may not cover the whole ostium, leading to residual leaks, which can lead to nidus for thrombus formation. Although it technically sounds feasible but there are few challenges associated with double device implantation. Sealing of bi-lobed LAA is technically possible especially with favorable anatomy, which includes totally separated bodies of both lobes with adequate body sizes.