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Case report Open access

Immediate Cardioversion During Left Atrial Appendage Occlusion in Three Patients With Left Atrial Appendage Thrombus.

Sep 2026 · JACC Case Reports · Vol 31, pp. 110184 · 0 citations · 9 references
Medicine

TL;DR

DCCV during LAAO appears technically feasible in selected patients, although larger studies are needed to confirm safety, and no device migration, embolization, significant peridevice leak, or neurologic events occurred.

Abstract

Purpose

We report the first cases of direct current cardioversion (DCCV) performed during percutaneous left atrial appendage occlusion (LAAO) in patients with left atrial appendage thrombus and assess its technical feasibility.

Methods

Three patients with left atrial appendage thrombus and absolute indications for LAAO underwent DCCV during the procedure because of hemodynamic instability from rapid atrial fibrillation.

Results

A single 200-J shock restored sinus rhythm in all patients. No device migration, embolization, significant peridevice leak, or neurologic events occurred. Follow-up imaging confirmed stable device position.

Conclusions

DCCV during LAAO appears technically feasible in selected patients, although larger studies are needed to confirm safety.

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