Introduction
Atrial fibrillation (AF) is the most common sustained arrhythmia and is associated with an ischemic stroke risk which is mitigated by anticoagulation. In patients that are not suitable anticoagulation candidates, closure of the left atrial appendage (LAA) is an alternative to reduce the risk of thromboembolic stroke or systemic thromboembolism.[1, 2] In patients with a history of AF undergoing cardiac surgery, the LAA is often either ligated or amputated at the time of surgery, however the rates of incomplete surgical LAA ligation (ISLL) are high,[3, 4] and ISLL is associated with elevated risk of thrombus formation and thromboembolism, likely due to constriction of blood flow into the LAA.[5] In other patients with elevated risk of thromboembolism from AF, endovascular closure of the LAA is often attempted. This approach has been shown to be superior to warfarin for the end point of stroke, systemic embolism, and cardiovascular death, as well as all-cause mortality.[6] However, residual communications between the LA and the LAA are relatively common. While small communications have been shown not to be associated with elevated thromboembolic risk,[7] leaks >5 mm typically require treatment. In this case series, we report 5 consecutive cases of residual communication between the LAA and the LA which were closed by endovascular techniques.