Percutaneous closure of left atrial appendage to prevent embolic events in high-risk patients with chronic atrial fibrillation.
BACKGROUND
Percutaneous closure of the left atrial appendage (LAA) is a novel alternative for the treatment of patients with atrial fibrillation (AF) and with a high risk of stroke who are not eligible for long-term anticoagulation therapy. The aim of this study was to asses the safety, feasibility, and long-term efficacy of this procedure.


METHODS
From July 2004 to June 2007, 20 patients (13 male, mean age 69 +/- 8 years) with non-valvular AF (NV-AF) underwent LAA percutaneous closure using the PLAATO system, implanted through a transeptal access. All patients had contraindications to anticoagulant therapy and were at high risk for cardioembolic stroke (mean CHADS(2) score 3 +/- 1.2). A trans-thoracic echocardiogram was performed at 1, 3, and every 6 months after the procedure, whereas a trans-oesophageal echocardiogram (TOE) was scheduled at 6 months. After 24 months, a phone interview was obtained.


RESULTS
All procedures were successfully performed in 18 patients. In two patients, LAA closure was not feasible for the presence of a multilobed LAA. Two patients underwent percutaneous closure of patent foramen ovale in the same session. In one patient, the procedure was complicated by cardiac perforation with pericardial effusion, treated with pericardiocentesis. At a mean follow up of 40 +/- 10 months, no embolic events occurred. One patient died, after 36 months, for gastric cancer. TOE examination showed the complete exclusion of the LAA in all patients.


CONCLUSIONS
Percutaneous closure of LAA is safe and efficacious to prevent stroke in patients with NV-AF at high risk for cardioembolic events, with contraindications to anticoagulant therapy.
Ussia
Gian Paolo
GP
Division of Cardiology, Ferrarotto Hospital, University of Catania, Catania, Italy. gpussia@hotmail.com
Mulè
Massimiliano
M
Cammalleri
Valeria
V
Scarabelli
Marilena
M
Barbanti
Marco
M
Immè
Sebastiano
S
Mangiafico
Sarah
S
Marchese
Anna
A
Galassi
Alfredo Ruggero
AR
Tamburino
Corrado
C
D000368:Aged; D000925:Anticoagulants; D020517:Atrial Appendage; D001281:Atrial Fibrillation / Q000150:complications / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000628:therapy*; D006328:Cardiac Catheterization / Q000009:adverse effects / Q000295:instrumentation; D002908:Chronic Disease; D000075202:Contraindications; D017548:Echocardiography, Transesophageal; D004617:Embolism / Q000209:etiology / Q000517:prevention & control*; D004867:Equipment Design; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D018570:Risk Assessment; D020521:Stroke / Q000209:etiology / Q000517:prevention & control*; D013997:Time Factors; D016896:Treatment Outcome
D000925:Anticoagulants; D010975:Platelet Aggregation Inhibitors