February 14, 2013Catheterization and Cardiovascular Interventions

Amplatzer left atrial appendage occlusion: Single center 10‐year experience

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Structured PICO

Population

152 patients undergoing left atrial appendage occlusion, mean age 72 ± 10 years, 105 males. Mean CHA2DS2-VASc score 3.4 ± 1.7, HAS-BLED score 2.4 ± 1.2.

Intervention

Left atrial appendage occlusion using Amplatzer devices (nondedicated in 21%, dedicated Amplatzer Cardiac Plugs in 79%) performed under local anesthesia without transesophageal echocardiography, followed by acetylsalicylic acid and clopidogrel for 1-6 months.

Outcome

Short-term safety endpoints (procedural complications, bleeds) and efficacy endpoints (death, stroke, systemic embolization).composite

Left atrial appendage occlusion using Amplatzer devices without transesophageal echocardiography guidance is feasible and shows acceptable intermediate-term safety and efficacy, though dedicated devices have lower embolization rates.

Limitations

observational study design
potential biases

Implication

Dedicated devices linked to lower embolization in LAAO; observational data leave comparative safety open for randomized confirmation.

Abstract

OBJECTIVES: To report a 10-year single center experience with Amplatzer devices for left atrial appendage (LAA) occlusion. BACKGROUND: Intermediate-term outcome data following LAA occlusion are scarce. METHODS: Short- and intermediate-term outcomes of patients who underwent LAA occlusion were assessed. All procedures were performed under local aesthesia without transesophageal echocardiography. Patients were discharged on acetylsalicylic acid and clopidogrel for 1-6 months. RESULTS: LAA occlusion was attempted in 152 patients (105 males, age 72 ± 10 years, CHA2 DS2 -Vasc-score 3.4 ± 1.7, HAS-BLED-score 2.4 ± 1.2). Nondedicated devices were used in 32 patients (21%, ND group) and dedicated Amplatzer Cardiac Plugs were used in 120 patients (79%, ACP group). A patent foramen ovale or atrial septal defect was used for left atrial access and closed at the end of LAA occlusion in 40 patients. The short-term safety endpoints (procedural complications, bleeds) occurred in 15 (9.8%) and the efficacy endpoints (death, stroke, systemic embolization) in 0 patients. Device embolization occurred more frequently in the ND as compared to the ACP group (5 patients or 12% vs. 2 patients or 2%). Mean intermediate-term follow up of the study population was 32 months (range 1-120). Late deaths occurred in 15 patients (5 cardiovascular, 7 noncardiac, 3 unexplained). Neurologic events occurred in 2, peripheral embolism in 1, and major bleeding in 4 patients. The composite efficacy and safety endpoint occurred in 7% and 12% of patients. CONCLUSION: LAA closure may be a good alternative to oral anticoagulation. This hypothesis needs to be tested in a randomized clinical trial to ensure that all potential biases of this observational study are accounted for.