RT Journal Article
SR Electronic
T1 Outcome of left atrial appendage occlusion in high-risk patients
JF Heart
JO Heart
FD BMJ Publishing Group Ltd and British Cardiovascular Society
SP 594
OP 599
DO 10.1136/heartjnl-2017-312383
VO 104
IS 7
A1 Ahmed Masoud
A1 Stefano Bartoletti
A1 Timothy Fairbairn
A1 Ayush Khurana
A1 Periaswamy Velavan
A1 William Lindsay Morrison
A1 Afshin Khalatbari
A1 Suneil Aggarwal
A1 Nikhill Sharma
A1 Paulus Kirchhof
A1 Dhiraj Gupta
YR 2018
UL http://heart.bmj.com/content/104/7/594.abstract
AB Objective Percutaneous left atrial appendage (LAA) occlusion can be an interventional alternative to oral anticoagulation for stroke prevention in patients with atrial fibrillation.Methods We delivered LAA occlusion therapy using a standardised approach to patient referral, multidisciplinary team assessment, implant criteria, imaging and follow-up. We analysed patient characteristics, efficacy and safety of the implant procedure, and 12-month outcomes.Results Of 143 referrals from October 2014 to December 2016, 83 patients (age 76±8years, 32.5% female, mean CHAD2S2-VASc score 4 ±1) were offered LAA occlusion. Eighty (95.3%) had previous major bleeding (intracranial in 59%). LAA occluder implantation with an Amulet device was successful in 82 (98.8%), with periprocedural major adverse events occurring in 5 (6.0%) patients (2 device embolisations including 1 death, 2 major bleeds). Cardiac imaging in 75 (94%) patients 2months following implant showed device-related thrombus in 1 case (1.3%) and minor (<5mm) device leaks in 13 (17.1%). Over a median 12-month follow-up, 3 (3.8%) ischaemic strokes, 2 (2.5%) haemorrhagic strokes and 5 (6.3%) major extracranial bleeds occurred. All-cause mortality was 10%, with most deaths (7, 87.5%) due to non-cardiovascular causes.Conclusions LAA occlusion may be a reasonable option for stroke prevention inhigh-risk patients with atrial fibrillation ineligible for anticoagulation. However, procedural complication rates are not insignificant, and patients remain at risk of serious adverse events and death even after successful implant.