Pericardial access-related complications have been reported in 4–5 % of cases during percutaneous ligation of the left atrial appendage (LAA) with LARIAT device (1, 2). An 82 year-old lady with atrial fibrillation and contraindication to anticoagulation underwent LARIAT device insertion. Pericardial effusion was noted on transesophageal echocardiography soon after subxiphoid access. Pericardiocentesis was performed with auto-transfusion into the femoral vein for 90 min with no resolution of the effusion. Sternotomy was performed by the surgical team which revealed profuse active bleeding from a large RV laceration (Video). A 4–0 Prolene pledgeted suture was inserted to control the bleeding (Fig. 1). LAA was occluded with an Atriclip (Atricure Inc. Cincinnati, OH) 45 mm device (Fig 2). The patient had an uneventful postoperative course. This case emphasizes prompt surgical consultation in pericardial access-related complications during LARIAT device insertion.

Fig. 1
figure 1

Insertion of a 4–0 Prolene pledgeted suture to control bleeding

Full size image
Fig. 2
figure 2

Occlusion of the LAA with an Atriclip 45 mm device

Full size image