Complications Following Percutaneous Left Atrial Appendage Occlusion

Pericardial effusion (PE) with associated tamponade is the most common serious complication following left atrial appendage occlusion (LAAO), but its incidence has reduced with improved technique and newer generation devices. Device-related thrombus is an infrequent but significant complication after LAAO and requires continued oral anticoagulation. Procedure-associated thromboembolism may occur from clot formation in the heart due to subtherapeutic intraprocedural anticoagulation or air embolism from inadequate de-airing of equipment. Device embolization is a rare but potentially lethal complication and may require surgical extraction of the device depending on location. Peri-device leaks have been associated with increased risk of thromboembolism and may be treated with endovascular plugs, radiofrequency ablation, or coil embolization depending on size. Numerous randomized controlled trials and multicenter registries over the past decade have provided a wealth of information regarding complications following LAAO. It is also important to highlight that increased operator experience and widespread adoption of LAAO implantation techniques have led to a substantial decrease in acute and severe complications such as device embolization and major thromboembolism.