Transcatheter closure of left atrial appendage with the Amplatzer® Cardiac Plug in patients with atrial fibrillation and high risk of thromboembolic events - early experience

Background: Atrial fibrillation is the most common arrythmia in patients beyond 65 years of age. Several of those patients have contraindications to coumadin treatment. Ninety percent of atrial thrombi related to atrial fibrillation are found in the left atrial appendage. Aim: We present our early experience with the left atrial appendage transcatheter closure using the Amplatzer (R) Cardiac Plug. Methods: Transcatheter closure was performed in general anaesthesia and under transoesophageal echocardiography control in three patients aged 69, 73 and 61 years (two female). All had atrial fibrillation with high risk of thromboembolic events (CHADS(2) score >= 2 points). In all of them coumadin treatment was contraindicated. Results: The procedure time was 112, 109 and 60 min (fluoroscopy time: 25, 29 and 12,5 min). The Amplatzer (R) Cardiac Plugs of 24, 26 and 22 mm were implanted successfully and without complications. The day after, transthoracic echocardiogram revealed proper position of the implant and complete occlusion of the appendage in all patients. The patients were discharged on antiplatelet treatment. Conclusion: Transcatheter left atrial appendage closure with the Amplatzer (R) Cardiac Plug may be a promissing therapeutic option for patients with atrial fibrillation-related high risk of thromboembolic events and with contraindications to anti-vitamin K treatment.