Clinical Research
Mini-Focus: Left Atrial Closure in Atrial Fibrillation
Percutaneous Left Atrial Appendage Closure With the AMPLATZER Cardiac Plug Device in Patients With Nonvalvular Atrial Fibrillation and Contraindications to Anticoagulation Therapy

https://doi.org/10.1016/j.jacc.2013.02.089Get rights and content
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Objectives

The aim of this study was to evaluate the results associated with left atrial appendage closure (LAAC) with the AMPLATZER Cardiac Plug (ACP) (St. Jude Medical, Minneapolis, Minnesota) in patients with nonvalvular atrial fibrillation and absolute contraindications to anticoagulation therapy.

Background

Few data exist on the late outcomes after LAAC in patients with absolute contraindications to warfarin.

Methods

A total of 52 patients with nonvalvular atrial fibrillation underwent LAAC with the ACP device in 7 Canadian centers. Most patients received short-term (1 to 3 months) dual-antiplatelet therapy after the procedure and single-antiplatelet therapy thereafter. A transesophageal echocardiography was performed in 74% of patients at the 6-month follow-up. No patient was lost to follow-up (≥12 months in all patients).

Results

The mean age and median (interquartile range) CHADS2 score were 74 ± 8 years and 3 (2 to 4), respectively. The procedure was successful in 98.1% of the patients, and the main complications were device embolization (1.9%) and pericardial effusion (1.9%), with no cases of periprocedural stroke. At a mean follow-up of 20 ± 5 months, the rates of death, stroke, systemic embolism, pericardial effusion, and major bleeding were 5.8%, 1.9%, 0%, 1.9%, and 1.9%, respectively. The presence of mild peridevice leak was observed in 16.2% of patients at the 6-month follow-up as evaluated by transesophageal echocardiography. There were no cases of device thrombosis.

Conclusions

In patients with nonvalvular atrial fibrillation at high risk of cardioembolic events and absolute contraindications to anticoagulation, LAAC using the ACP device followed by dual-/single-antiplatelet therapy was associated with a low rate of embolic and bleeding events after a mean follow-up of 20 months. No cases of severe residual leak or device thrombosis were observed at the 6-month follow-up.

Key Words

AMPLATZER Cardiac Plug
anticoagulation
atrial fibrillation
percutaneous closure of left atrial appendage

Abbreviations and Acronyms

ACP
AMPLATZER Cardiac Plug
LAA
left atrial appendage
LAAC
left atrial appendage closure
MAE
major adverse event(s)
NVAF
nonvalvular atrial fibrillation
TEE
transesophageal echocardiography
TIA
transient ischemic attack

Cited by (0)

Drs. Rodés-Cabau, Webb, Horlick, Osten, and Ibrahim are consultants for St. Jude Medical. Dr. Saw is a proctor for St. Jude Medical. Dr. Ibrahim is a proctor for St. Jude Medical and Gore Medical; and has financial relationships (lectures and advisory boards) with Boston Scientific and Medtronic. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.