Termination of anticoagulation therapy at 45 days after concomitant atrial fibrillation catheter ablation and left atrial appendage occlusion resulting in device-related thrombosis and stroke.

Catheter ablation therapy for atrial fibrillation (AF) is a safe and effective treatment for patients with both paroxysmal and persistent symptomatic AF. However, given the uncertainty about recurrence after the ablation procedure and continued risk of thromboembolism, it is still recommended to treat with anticoagulation for the long-term prevention of stroke. Left atrial appendage (LAA) occlusion with the WATCHMAN device (Boston Scientific Corp., Natick, MA) has demonstrated equivalent reduction in stroke compared to warfarin as well as a mortality benefit in patients with AF and CHADS2VASC2 score >1,1,2 and it is increasingly being used as an alternative to warfarin for long-term prevention of stroke.