LEFT ATRIAL APPENDAGE CLOSURE

CASE REPORT

Abstract

People with atrial fibrillation (AF) have five times greater risk of having a stroke than people who do not respond to this problem. Stroke secondary to AF has been associated with mortality rates and high permanent disability, since its effective prevention is important. Mechanical methods for the occlusion of the LAA have been developed as an alternative to oral anticoagulation for patients with contraindications or complications derived from anticoagulation. The case is a male patient, 86 years old, hypertensive and with AF who was admitted to our service on 06/07/2020 with a picture of lipothymia, dyspnea and chest pain associated with bradycardia (HR of 32bpm) and rhythm of total atrioventricular block with AF, he was admitted to the ICU, a transvenous transient pacemaker was passed, atenolol was suspended and full anticoagulation with enoxaparin was started. However, he developed an important melena condition on 12/06/2020 with a hematimetric fall and the need for blood transfusion, with anticoagulation and investigation with EDA and colonoscopy being suspended. He underwent a transesophageal echocardiogram and an electrophysiological study to assess cardioversion and AF ablation. Two protections from electrical cardioversion were performed without success. Patient is discharged from the hospital on 06/21/2020 using Eliquis 5mg twice a day associated with clopidogrel. However, on 06/07/2020, the patient evolved with a hematoma contained in a retropeitorial right hemithorax, a dose of Eliquis® was reduced to 2.5 mg twice a day, the patient maintained a persistent hematoma and the anticoagulant was then suspended and scheduled to close the LAA.