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Original article
Left atrial appendage occlusion in high-risk patients with non-valvular atrial fibrillation
  1. Sergio Berti1,
  2. Luigi Emilio Pastormerlo1,2,
  3. Marco Rezzaghi1,
  4. Giuseppe Trianni1,
  5. Umberto Paradossi1,
  6. Elisa Cerone1,
  7. Marcello Ravani1,
  8. Alberto Ranieri De Caterina1,
  9. Antonio Rizza1,
  10. Cataldo Palmieri1
  1. 1Fondazione Toscana G. Monasterio—Ospedale del Cuore G. Pasquinucci, Massa, Italy
  2. 2Scuola Superiore Sant'Anna—Istituto di Scienze della Vita, Pisa, Italy
  1. Correspondence to Dr Sergio Berti, Fondazione Toscana Gabriele Monasterio—Ospedale del Cuore G. Pasquinucci, Via Aurelia Sud, Massa 54100, Italy; berti{at}ftgm.it

Abstract

Objective Percutaneous left atrial appendage (LAA) occlusion has been developed as a viable option for stroke and thromboembolism prevention in patients with non-valvular atrial fibrillation (NVAF) and at high risk for cerebral cardioembolic events. Data on device implantation and long-term follow-up from large cohorts are limited.

Methods 110 consecutive patients with NVAF and contraindications to oral anticoagulants (OACs) underwent LAA occlusion procedures and achieved a longer than 1 year follow-up. All patients were enrolled in a prospective registry. Procedures were performed using the Amplatzer Cardiac Plug or Amulet guided by fluoroscopy and intracardiac echocardiography.

Results Mean age of the population was 77±6 years old; 68 were men. Atrial fibrillation was paroxysmal in 20%, persistent in 15.5% and permanent in 64.5% of cases, respectively. Mean CHA2DS2-VASc and HAS-BLED scores were 4.3±1.3 and 3.4±1, respectively. Technical success (successful deployment and implantation of device) was achieved in 100% of procedures. Procedural success (technical success without major procedure-related complications) was achieved in 96.4%, with a 3.6% rate of major procedural complications (three cases of pericardial tamponade requiring drainage and one case of major bleeding). Mean follow-up was 30±12 months (264 patient-years). Annual rates for ischaemic stroke and for other thromboembolic events were respectively 2.2% and 0%, and annual rate for major bleeding was 1.1%.

Conclusions Our data suggest LAA occlusion in high-risk patients with NVAF not suitable for OACs is feasible and associated with low complication rates as well as low rates of stroke and major bleeding at long-term follow-up.

  • Stroke

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Footnotes

  • Contributors SB, GT, MR, ARDC, UP, AR and CP were personally involved in the procedures of LAA occlusion, contributed to data analysis and to the writing of the manuscript. LEP and MR acted as main data collectors and wrote the different versions of the manuscript. EC helped in data collection and analysis.

  • Competing interests SB is proctor for St. Jude Medical and Edwards Lifesciences. The other authors report that no potential conflicts of interest exist with any companies/organisations whose products or services may be discussed in this article.

  • Ethics approval Comitato Etico di Massa e Carrara.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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