Introduction:
Epicardial exclusion of LAA has gained increasing popularity since its introduction in 2009. However, there are single center studies of this technique for standalone stroke risk reduction in patients with AF.1-3 While the clip has demonstrated a success rate ranging from 93.9-100% in excluding the LAA, one significant complication is incomplete exclusion due to residual stump greater than 1 cm as a result of clip being deployed too distally.1We describe here a solution to that complication, which is the first reported case of implanting a second clip underneath the first clip to obliterate the residual stump.