Left Atrial Appendage Closure with Amplatzer Cardiac Plug in Nonvalvular Atrial Fibrillation: Safety and Long-Term Outcome

Abstract

BackgroundAtrial fibrillation (AF) is a cardiac arrhythmia with high risk for thromboembolic events, specially stroke.ObjectiveTo assess the safety of left atrial appendage closure (LAAC) with the Amplatzer Cardiac Plug for the prevention of thromboembolic events in patients with nonvalvular AF.MethodsThis study included 15 patients with nonvalvular AF referred for LAAC, 6 older than 75 years (mean age, 69.4 ± 9.3 years; 60% of the male sex).ResultsThe mean CHADS2 score was 3.4 ± 0.1, and mean CHA2DS2VASc , 4.8 ± 1.8, evidencing a high risk for thromboembolic events. All patients had a HAS-BLED score > 3 (mean, 4.5 ± 1.2) with a high risk for major bleeding within 1 year. The device was successfully implanted in all patients, with correct positioning in the first attempt in most of them (n = 11; 73.3%).ConclusionThere was no periprocedural complication, such as device migration, pericardial tamponade, vascular complications and major bleeding. All patients had an uneventful in-hospital course, being discharged in 2 days. The echocardiographic assessments at 6 and 12 months showed neither device migration, nor thrombus formation, nor peridevice leak. On clinical assessment at 12 months, no patient had thromboembolic events or bleeding related to the device or risk factors. In this small series, LAAC with Amplatzer Cardiac Plug proved to be safe, with high procedural success rate and favorable outcome at the 12-month follow-up.

Left Atrial Appendage Transcatheter Occlusion with AMPLATZERT AmuletT Device: Real Life Data with Mid-Term Follow-Up Results

“…17 We did not observe DRT in our patients with TEE imaging at the 1 st , 6 th , and 12 th month after LAA occlusion, corroborating their results. 17 There is some controversy among studies regarding thrombus formation over the device. The individualized antiplatelet treatment may explain this difference in our patient series.…”

“…Interestingly, DAPT at discharge was associated with a lower risk of thrombus, and only 23.2% of the study group was discharged with this treatment. Costa et al 17 published patient outcomes over a 12-month follow-up and found no DRT. 17 We did not observe DRT in our patients with TEE imaging at the 1 st , 6 th , and 12 th month after LAA occlusion, corroborating their results.…”

“…Costa et al 17 published patient outcomes over a 12-month follow-up and found no DRT. 17 We did not observe DRT in our patients with TEE imaging at the 1 st , 6 th , and 12 th month after LAA occlusion, corroborating their results. 17 There is some controversy among studies regarding thrombus formation over the device.…”

Percutaneous Occlusion of Left Atrial Appendage: Growing Clinical Experience and Lack of Multicenter Randomized Clinical Trials

“…In the second registry, Marcio Costa et al, 13 evaluated 15 patients with nonvalvular AF and high risk of bleeding, submitted to implantation of the ACP prosthesis. In this small series, the procedure was successfully performed in all cases with no reports of hemopericardium or prosthesis displacement.…”