Echocardiographic Diagnosis of Watchman Device Infection: An Unusual Complication

Left atrial appendage occlusion devices (LAAOD) are approved to reduce thromboembolism risk in patients with atrial fibrillation and contraindication to anticoagulation. LAAOD-associated endocarditis is rarely reported, and Streptococcus alactolyticus is a rarely identified organism in endocarditis. In this case, a 71-year-old man was diagnosed with Streptococcus alactolyticus LAAOD-associated endocarditis five years after implant. He was bacteremic, and a transesophageal echocardiogram demonstrated a mobile 1.2 cm vegetation adherent to the device. Optimal treatment for LAAOD infection is unknown. He was treated with antibiotics because surgical removal carried unacceptable risk. This case demonstrates a rare LAAOD infection years after implant.