{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,3]],"date-time":"2026-06-03T00:56:57Z","timestamp":1780448217186,"version":"3.54.1"},"reference-count":23,"publisher":"Oxford University Press (OUP)","issue":"3","license":[{"start":{"date-parts":[[2026,1,19]],"date-time":"2026-01-19T00:00:00Z","timestamp":1768780800000},"content-version":"vor","delay-in-days":2495,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2019,3,22]],"date-time":"2019-03-22T00:00:00Z","timestamp":1553212800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2019,6,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>As an alternative to oral anticoagulation, percutaneous left atrial appendage (LAA) closure is an increasingly performed procedure to prevent arterial embolism in patients with non-valvular atrial fibrillation. Besides procedure-related complications, residual leaks, device-related thrombus formation, and dislocation of the LAA occluder have been observed during follow-up. Heart failure as a consequence of interventional LAA closure has not been reported so far. This case report describes a 79-year-old lady with permanent non-valvular atrial fibrillation presenting with New York Heart Association Class IV heart failure. Symptoms had started immediately after attempted LAA closure 11 months before. Transoesophageal echocardiography demonstrated two devices in the LAA, a large peri-device leak, a mobile LAA thrombus, a right atrial appendage thrombus, and shunting via a patent foramen ovale. Under a maximally tolerated dose of heart failure medication and edoxaban, the patient remains without bleeding or embolism in New York Heart Association Class II. Because of its unique anatomical and endocrine properties, the LAA plays an important role in situations of pressure and volume overload. Interventional LAA closure interacts unfavourably with left atrial compliance and reservoir function. Atrial and brain natriuretic peptide secretion is known to be significantly reduced after LAA closure. Both mechanisms may result in the development of heart failure. Attempted LAA closure\u2014instead of being the solution\u2014may create new serious problems. Development of heart failure should be assessed, and a systematic search for late leaks after LAA closure should be performed in trials investigating safety and efficacy of this intervention.<\/jats:p>","DOI":"10.1002\/ehf2.12435","type":"journal-article","created":{"date-parts":[[2019,3,23]],"date-time":"2019-03-23T00:09:35Z","timestamp":1553299775000},"page":"570-574","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":9,"title":["A 79-Year-Old Woman with Atrial Fibrillation and New Onset of Heart Failure"],"prefix":"10.1093","volume":"6","author":[{"given":"Birke","family":"Schneider","sequence":"first","affiliation":[{"name":"Sana Kliniken L\u00fcbeck , Kahlhorststrasse 17, L\u00fcbeck, D-23562 ,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dirk","family":"Nazarenus","sequence":"additional","affiliation":[{"name":"Private Office , L\u00fcbeck ,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Claudia","family":"St\u00f6llberger","sequence":"additional","affiliation":[{"name":"Krankenanstalt Rudolfstiftung , Vienna ,","place":["Austria"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2019,3,22]]},"reference":[{"key":"2026012115094780800_ehf212435-bib-0001","doi-asserted-by":"crossref","first-page":"2893","DOI":"10.1093\/eurheartj\/ehw210","article-title":"2016 ESC guidelines for the management of atrial fibrillation developed in collaboration with EACTS","volume":"37","author":"Kirchhof","year":"2016","journal-title":"Eur Heart J"},{"key":"2026012115094780800_ehf212435-bib-0002","doi-asserted-by":"crossref","first-page":"2964","DOI":"10.1016\/j.jacc.2017.10.021","article-title":"5-year outcomes after left atrial appendage closure: from the PREVAIL and PROTECT AF trials","volume":"70","author":"Reddy","year":"2017","journal-title":"J Am Coll Cardiol"},{"key":"2026012115094780800_ehf212435-bib-0003","doi-asserted-by":"crossref","first-page":"874","DOI":"10.1161\/CIRCULATIONAHA.118.035090","article-title":"Device-related thrombus after left atrial appendage closure: incidence, predictors, and outcomes","volume":"138","author":"Dukkipati","year":"2018","journal-title":"Circulation"},{"key":"2026012115094780800_ehf212435-bib-0004","doi-asserted-by":"crossref","first-page":"755","DOI":"10.1016\/0003-4975(95)00887-X","article-title":"Appendage obliteration to reduce stroke in cardiac surgical patients with atrial fibrillation","volume":"61","author":"Blackshear","year":"1996","journal-title":"Ann Thorac Surg"},{"key":"2026012115094780800_ehf212435-bib-0005","doi-asserted-by":"crossref","first-page":"718","DOI":"10.1016\/S1010-7940(00)00419-X","article-title":"The left atrial appendage: our most lethal human attachment! Surgical implications","volume":"17","author":"Johnson","year":"2000","journal-title":"Eur J Cardiothorac Surg"},{"key":"2026012115094780800_ehf212435-bib-0006","doi-asserted-by":"crossref","first-page":"2356","DOI":"10.1378\/chest.124.6.2356","article-title":"Elimination of the left atrial appendage to prevent stroke or embolism? Anatomic, physiologic, and pathophysiologic considerations","volume":"124","author":"St\u00f6llberger","year":"2003","journal-title":"Chest"},{"key":"2026012115094780800_ehf212435-bib-0007","doi-asserted-by":"crossref","first-page":"2363","DOI":"10.1161\/CIRCULATIONAHA.110.004747","article-title":"Risk of bleeding with 2 doses of dabigatran compared with warfarin in older and younger patients with atrial fibrillation: an analysis of the randomized evaluation of long-term anticoagulant therapy (RE-LY) trial","volume":"123","author":"Eikelboom","year":"2011","journal-title":"Circulation"},{"key":"2026012115094780800_ehf212435-bib-0008","doi-asserted-by":"crossref","first-page":"1544","DOI":"10.1111\/bcp.13580","article-title":"Preventability of serious thromboembolic and bleeding events related to the use of oral anticoagulants: a prospective study","volume":"84","author":"Sennesael","year":"2018","journal-title":"Br J Clin Pharmacol"},{"key":"2026012115094780800_ehf212435-bib-0009","first-page":"H1356","article-title":"Regional atrial distensibility","volume":"262","author":"Hoit","year":"1992","journal-title":"Am J Physiol"},{"key":"2026012115094780800_ehf212435-bib-0010","doi-asserted-by":"crossref","first-page":"167","DOI":"10.1161\/01.RES.72.1.167","article-title":"Altered left atrial compliance after atrial appendectomy. Influence on left atrial and ventricular filling","volume":"72","author":"Hoit","year":"1993","journal-title":"Circ Res"},{"key":"2026012115094780800_ehf212435-bib-0011","doi-asserted-by":"crossref","first-page":"225","DOI":"10.1536\/ihj.36.225","article-title":"The role of the left atrial appendage. A volume loading study in open-chest dogs","volume":"36","author":"Hondo","year":"1995","journal-title":"Jpn Heart J"},{"key":"2026012115094780800_ehf212435-bib-0012","first-page":"H1006","article-title":"Compliance of left atrium with and without left atrium appendage","volume":"259","author":"Davis","year":"1990","journal-title":"Am J Physiol"},{"key":"2026012115094780800_ehf212435-bib-0013","doi-asserted-by":"crossref","first-page":"364","DOI":"10.1161\/01.CIR.88.2.364","article-title":"Molecular forms of atrial natriuretic factor in normal and failing human myocardium","volume":"88","author":"Rodeheffer","year":"1993","journal-title":"Circulation"},{"key":"2026012115094780800_ehf212435-bib-0014","first-page":"448","article-title":"Atrial and brain natriuretic peptide secretion after percutaneous closure of the left atrial appendage with the WATCHMAN device","volume":"27","author":"Majunke","year":"2015","journal-title":"J Invasive Cardiol"},{"key":"2026012115094780800_ehf212435-bib-0015","first-page":"E39","article-title":"Brain natriuretic peptide levels variation after left atrial appendage occlusion","volume":"87","author":"Cruz-Gonzalez","year":"2016","journal-title":"Catheter Cardiovasc Interv"},{"key":"2026012115094780800_ehf212435-bib-0016","first-page":"4","article-title":"Percutaneous left atrial appendage occlusion: the Munich consensus document on definitions, endpoints, and data collection requirements for clinical studies","volume":"19","author":"Tzikas","year":"2017","journal-title":"Europace"},{"key":"2026012115094780800_ehf212435-bib-0017","first-page":"245","article-title":"Occurrence of incomplete endothelialization causing residual permeability after left atrial appendage closure","volume":"30","author":"Granier","year":"2018","journal-title":"J Invasive Cardiol"},{"key":"2026012115094780800_ehf212435-bib-0018","first-page":"1324","article-title":"Catheter-based closure of residual leaks after percutaneous occlusion of the left atrial appendage","volume":"87","author":"Hornung","year":"2016","journal-title":"Catheter Cardiovasc Interv"},{"key":"2026012115094780800_ehf212435-bib-0019","doi-asserted-by":"crossref","first-page":"128","DOI":"10.1111\/echo.13413","article-title":"Transesophageal echocardiographic diagnosis of a WATCHMAN left atrial appendage closure device thrombus 10 years following implantation","volume":"34","author":"Shamim","year":"2017","journal-title":"Echocardiography"},{"key":"2026012115094780800_ehf212435-bib-0020","doi-asserted-by":"crossref","first-page":"294","DOI":"10.1186\/s12872-017-0728-6","article-title":"Left atrial enlargement and clinical considerations in patients with or without a residual interatrial shunt after closure of the left atrial appendage with the WATCHMAN\u2122-device","volume":"17","author":"Luani","year":"2017","journal-title":"BMC Cardiovasc Disord"},{"key":"2026012115094780800_ehf212435-bib-0021","doi-asserted-by":"crossref","first-page":"455","DOI":"10.1111\/j.1540-8167.2011.02216.x","article-title":"Intraprocedural and long-term incomplete occlusion of the left atrial appendage following placement of the WATCHMAN device: a single center experience","volume":"23","author":"Bai","year":"2012","journal-title":"J Cardiovasc Electrophysiol"},{"key":"2026012115094780800_ehf212435-bib-0022","doi-asserted-by":"crossref","first-page":"127","DOI":"10.1007\/s11306-017-1255-2","article-title":"Occlusion of left atrial appendage affects metabolomic profile: focus on glycolysis, tricarboxylic acid and urea metabolism","volume":"13","author":"Sattler","year":"2017","journal-title":"Metabolomics"},{"key":"2026012115094780800_ehf212435-bib-0023","doi-asserted-by":"crossref","first-page":"5894","DOI":"10.1038\/s41598-018-23935-w","article-title":"Percutaneous closure of left atrial appendage significantly affects lipidome metabolism","volume":"8","author":"Y\u00fccel","year":"2018","journal-title":"Sci Rep"}],"container-title":["ESC Heart Failure"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/ehf2.12435","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/ehf2.12435","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/academic.oup.com\/eschf\/article-pdf\/6\/3\/570\/66135770\/eschf_6_3_570.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/eschf\/article-pdf\/6\/3\/570\/66135770\/eschf_6_3_570.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,1,21]],"date-time":"2026-01-21T20:12:43Z","timestamp":1769026363000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/eschf\/article\/6\/3\/570\/8403592"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,3,22]]},"references-count":23,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2019,3,22]]},"published-print":{"date-parts":[[2019,6,1]]}},"URL":"https:\/\/doi.org\/10.1002\/ehf2.12435","relation":{},"ISSN":["2055-5822"],"issn-type":[{"value":"2055-5822","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2019,6]]},"published":{"date-parts":[[2019,3,22]]},"assertion":[{"value":"2018-09-13","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2019-02-26","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2019-03-22","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}