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The cryoballoon as a bailout in a severely perforated left atrial appendage: a case report. Introduction: Interventional left atrial appendage (LAA) occlusion is frequently performed in patients with atrial fibrillation with contraindications for or complications under oral anticoagulation or patients after electrical LAA isolation. Case presentation: An endocardial LAA occlusion was attempted but resulted in perforation of the distal LAA and severe pericardial tamponade. To prevent open heart surgery, a cryoballoon was advanced to the base of the LAA and inflation resulted in complete occlusion and stopped further pericardial bleeding. An epicardial LAA suture device was then successfully implanted and completely sealed the LAA. No further pericardial bleeding occurred, and the patient fully recovered. Discussion: A combination of a balloon device to occlude the base of the LAA and an epicardial suture device can be an emergency bail-out option in patients with a perforated LAA.