Oclusão do apêndice atrial esquerdo com o Amplatzer Cardiac Plug em pacientes com fibrilação atrial

Abstract

Results: All implants were guided by angiography alone. Procedural success was 99% (one patient suffered a cardiac tamponade requiring pericardiocentesis, and the procedure was waived). There were four major complications (the already mentioned cardiac tamponade, two transient ischemic attacks and one device embolization with percutaneous retrieval) and two minor complications (one pericardial effusion without clinical significance and one non-significant ASD evidenced at FU). There was one in-hospital death after six days, unrelated to the procedure. All other patients were discharged without OA. After 25.9 patient-years of FU (69 patients), there were no strokes and no late device embolization. The LAA was completely closed in 97% of the cases. Six patients showed evidence of thrombus formation on the device, which resolved after three months of OA. Conclusion

ANMCO/AIAC/SICI-GISE/SIC/SICCH Consensus Document: percutaneous occlusion of the left atrial appendage in non-valvular atrial fibrillation patients: indications, patient selection, staff skills, organisation, and training

“…In the registry of the PAC system, which contains the results achieved by skilled staff, the rate of pericardial effusion fell to 2.2% 74 and the same values were also reported in the subsequent PREVAIL trial 51 . The recent study performed by Tzikas et al 57 on the results achieved with the ACP device in more than 20 European and Canadian centres revealed a rate of pericardial effusion requiring drainage of 1.2%.…”

“…For the current generation of the device, the depth of the LAA must be similar to the diameter to allow safe deployment. In the Panel’s experience this characteristic, which is apparently the device’s biggest drawback, has never prevented safe implantation, probably because several studies 74 have shown that as AF persists, LAA increase in size, generally with the same rate of expansion in their diameter and depth. However, if in doubt it is important to use the radiopaque markers provided on the deployment system which easily reveal the minimum device deployment depth.…”

Pericardial tamponade as a complication of invasive cardiac procedures: a review of the literature

“…Being short, the ACP can be implanted in a shallow position in the LAA, as only the proximal 2 cm are needed for its occlusion. The occlusive disc permits the complete closure of the LAA orifice [59]. In a prospective randomized controlled trial by Holmes et al [60], with the intervention group consisting of 463 LAAC implantations, the most frequent primary safety event was severe pericardial effusion (defined as the need for percutaneous or surgical drainage).…”

Left Atrial Appendage: Physiology, Pathology, and Role as a Therapeutic Target

“…Observational studies with the ACP followed a regimen of clopidogrel + ASA for 1 month and acetylsalicylic acid for 3 to 6 months [ 60 ], borrowing the antithrombotic protocol from the experience with the Amplatzer PFO Occluder. In patients who are treated with antiplatelets drugs, it is reasonable to perform an imaging test (TEE or CT scan) before clopidogrel termination and again if ASA cessation is planned.…”