Management of Residual Left Atrial Appendage Stump with a Second Epicardial Clip.

Epicardial exclusion of LAA has gained increasing popularity since its introduction in 2009. While the clip has demonstrated a success rate ranging from 93.9-100% in excluding the LAA, one significant complication is incomplete exclusion due to residual stump (> 1 cm) as a result of the clip being deployed too distally. We describe here the first reported case of implanting a second clip underneath the first clip to obliterate the residual stump for a 71-year-old male with AF evaluated for intervention for stroke risk reduction.