Percutaneous left atrial appendage closure

Introduction: Atrial fibrillation is a growing epidemic in the western world. Stroke as the most dreaded complication is effectively prevented by oral anticoagulation. Although effective in preventing stroke, oral anticoagulants come at a price of bleeding complications. Concerns about bleeding lead to a high rate of drug discontinuation and is the reason many patients are not put on oral anticoagulants at all. Percutaneous left atrial appendage (LAA) closure is an excellent option for patients who cannot or who do not want to be on oral anticoagulants, since the left atrial appendage is the origin of more than 90% of clots arising from the left atrium. Methods: Using femoral venous access, a plug is placed in the left atrial appendage, thereby excluding this embryologic remnant from the circulation. The procedure can be performed on an outpatient basis. We report our own experience in 100 patients using the Amplatzer cardiac plug. Results: One hundred patients (72 +/- 10 years) underwent LAA closure using only local anesthesia and without transesophageal guidance. Imaging and sizing of the LAA was performed by contrast injections through the 13 French TorqVue delivery sheath, followed by device implantation. Clopidogrel was prescribed for 1 month and acetylsalicylic acid for 3-6 months. The procedure was successful in 98% of patients and was often performed in conjunction with other interventional procedures. Periprocedural complication rate was 6% (2% pericardial effusion, 2% device embolization, 2% transient neurologic symptoms) with no long-term sequelae. Conclusion: LAA closure is an attractive alternative to oral anticoagulation in patients suffering from atrial fibrillation. (C) 2012 Elsevier Masson SAS and European Union Geriatric Medicine Society. All rights reserved.