Amplatzer Left Atrial Appendage Occlusion: Single Center 10-Year Experience

ObjectivesTo report a 10-year single center experience with Amplatzer devices for left atrial appendage (LAA) occlusion. BackgroundIntermediate-term outcome data following LAA occlusion are scarce. MethodsShort- 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. ResultsLAA occlusion was attempted in 152 patients (105 males, age 7210 years, CHA(2)DS(2)-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. ConclusionLAA 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. (c) 2013 Wiley Periodicals, Inc.