{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,7,30]],"date-time":"2025-07-30T11:51:09Z","timestamp":1753876269807,"version":"3.41.2"},"reference-count":8,"publisher":"Oxford University Press (OUP)","issue":"1","license":[{"start":{"date-parts":[[2023,1,3]],"date-time":"2023-01-03T00:00:00Z","timestamp":1672704000000},"content-version":"vor","delay-in-days":7,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"name":"CVON-AFFIP","award":["914728"],"award-info":[{"award-number":["914728"]}]},{"name":"NWO-Vidi","award":["91717339"],"award-info":[{"award-number":["91717339"]}]},{"name":"Biosense Webster USA","award":["783454"],"award-info":[{"award-number":["783454"]}]},{"DOI":"10.13039\/501100022216","name":"Medical Delta","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100022216","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2022,12,27]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Although peri-device leakage is frequently observed after left atrial appendage occlusion (LAAO), there is no consensus on the optimal management strategy. It is unknown whether additional plugging should be preferred over surgical exclusion of the LAA, as experience with additional plugging is limited.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Case summary<\/jats:title>\n                  <jats:p>In this case report, we demonstrate the clinical implications of additional plugging and surgical exclusion in a 65-year-old male patient with peri-device leakage and recurrent thromboembolic events. After the recurrence of paroxysmal atrial fibrillation (AF) and a transient ischaemic attack despite adequate anticoagulation, the patient was opted for re-do pulmonary vein isolation and LAAO with a Watchman device. Due to multiple ischaemic strokes and recurrent AF in combination with significant peri-device leakage, additional plugging with a second device was performed. Post-procedurally, the patient had another ischaemic stroke and persisting peri-device leakage was observed during follow-up. Due to progressive symptoms of AF and patient\u2019s preference to discontinue DOAC, he underwent a Cox MAZE IV procedure, including amputation of the LAA with both devices. Within six months after surgery, the patient experienced two more ischaemic events. In the following two years, the patient remained free of any cerebrovascular accidents or recurrence of AF.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Discussion<\/jats:title>\n                  <jats:p>Additional plugging of peri-device leakage is not always successful in stroke prevention. In combination with recurrent AF, progressive symptoms, contraindication for oral anticoagulation, and patient\u2019s preference, surgical LAA exclusion could be preferred over additional plugging.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/ehjcr\/ytac494","type":"journal-article","created":{"date-parts":[[2023,1,3]],"date-time":"2023-01-03T01:31:32Z","timestamp":1672709492000},"source":"Crossref","is-referenced-by-count":1,"title":["Case report: peri-device leakage after percutaneous left atrial appendage occlusion: plug, clip, or amputate?"],"prefix":"10.1093","volume":"7","author":[{"given":"Nawin L","family":"Ramdat Misier","sequence":"first","affiliation":[{"name":"Department of Cardiology, Erasmus Medical Center , Doctor Molewaterplein 40, 3015 GD Rotterdam , the Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rohit K","family":"Kharbanda","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Erasmus Medical Center , Doctor Molewaterplein 40, 3015 GD Rotterdam , the Netherlands"},{"name":"Department of Cardiothoracic Surgery, Erasmus Medical Center , Doctor Molewaterplein 40, 3015 GD Rotterdam , the Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Frank R N","family":"van Schaagen","sequence":"additional","affiliation":[{"name":"Department of Cardiothoracic Surgery, Erasmus Medical Center , Doctor Molewaterplein 40, 3015 GD Rotterdam , the Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0259-6691","authenticated-orcid":false,"given":"Natasja M S","family":"de Groot","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Erasmus Medical Center , Doctor Molewaterplein 40, 3015 GD Rotterdam , the Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2023,1,3]]},"reference":[{"key":"2023012017100146200_ytac494-B1","doi-asserted-by":"crossref","first-page":"e125","DOI":"10.1161\/CIR.0000000000000665","article-title":"2019 AHA\/ACC\/HRS focused update of the 2014 AHA\/ACC\/HRS guideline for the management of patients with atrial fibrillation: A report of the American college of cardiology\/American heart association task force on clinical practice guidelines and the heart rhythm society in collaboration with the society of thoracic surgeons","volume":"140","author":"January","year":"2019","journal-title":"Circulation"},{"key":"2023012017100146200_ytac494-B2","doi-asserted-by":"crossref","first-page":"1324","DOI":"10.1002\/ccd.26318","article-title":"Catheter-based closure of residual leaks after percutaneous occlusion of the left atrial 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appendage closure with the watchman device in patients with atrial fibrillation: a PROTECT AF (percutaneous closure of the left atrial appendage versus warfarin therapy for prevention of stroke in patients with atrial fibrillation) substudy","volume":"59","author":"Viles-Gonzalez","year":"2012","journal-title":"J Am Coll Cardiol"},{"key":"2023012017100146200_ytac494-B6","doi-asserted-by":"crossref","first-page":"2081","DOI":"10.1056\/NEJMoa2101897","article-title":"Left atrial appendage occlusion during cardiac surgery to prevent stroke","volume":"384","author":"Whitlock","year":"2021","journal-title":"N Engl J Med"},{"key":"2023012017100146200_ytac494-B7","doi-asserted-by":"crossref","first-page":"893","DOI":"10.1016\/j.jacep.2018.03.009","article-title":"Thoracoscopic left atrial appendage clipping: A multicenter cohort analysis","volume":"4","author":"van Laar","year":"2018","journal-title":"JACC Clin 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