Introduction
Left atrial appendage (LAA) occlusion with the Watchman device (Boston Scientific, Marlborough, MA) is increasingly being used as an alternative for stroke prevention in patients with non-valvular atrial fibrillation (AF) at high risk of complications from long term anticoagulation (1). Although the procedure has an overall favorable safety profile, it does carry a small risk of serious complications. Compared to the initial PROTECT AF trial, the subsequent PREVAIL trial demonstrated a reduction in the incidence of procedural complications from 8.7% to 4.2%. In particular, post-procedural pericardial effusions requiring pericardiocentesis or surgery were significantly reduced, with only one reported case of cardiac perforation among 269 patients in the device group (1). Here we report a case of left atrial appendage perforation resulting from Watchman device deployment requiring emergency repair of the left atrium using sternotomy and cardiopulmonary bypass and discuss options for surgical management of this complication. Informed consent was waived by Institutional Review Board.