title: Left atrial appendage closure with AMPLATZER cardiac plug for stroke prevention in atrial fibrillation: initial Asia-Pacific experience.
abstract: BACKGROUND
  Left atrial appendage (LAA) is the main source of left atrial thrombus that causes stroke in patients with non-valvular atrial fibrillation (NVAF). This study reported the initial safety, feasibility, and 1-yr clinical outcomes following AMPLATZER cardiac plug (ACP) implantation in Asia-Pacific region.
  
  
  METHODS
  Twenty NVAF patients (16 males, age 68 ± 9 yr) with high risk for developing cardioembolic stroke (CHADS(2) score: 2.3 ± 1.3) and contraindications to warfarin received ACP implants from June 2009 to May 2010. Patients received general anesthesia (n = 9) or controlled propofol sedation (n = 11) and the procedures were guided by fluoroscopy and transesophageal echocardiography (TEE). Clinical follow-up was arranged at 1 month and then every 3 months after implantation, whereas, a TEE was scheduled at 1 month upon completion of dual anti-platelet therapy.
  
  
  RESULTS
  The LAA was successfully occluded in 19/20 patients (95%) at two Asian centers. One procedure was abandoned because of catheter-related thrombus formation. Other complications included coronary artery air embolism (n = 1) and TEE-attributed esophageal injury (n = 1). The median procedural and fluoroscopic times were 79 (IQR: 59-100) and 18 (IQR 12-27) minutes, respectively. The mean size of implant was 23.6 ± 3.1 mm. The average hospital stay was 1.8 ± 1.1 days. Follow-up TEE showed all the LAA orifices were sealed without device-related thrombus formation. No stroke or death occurred at a mean follow-up of 12.7 ± 3.1 months.
  
  
  CONCLUSIONS
  Our preliminary data suggested LAA closure with ACP is safe, feasible with encouraging 1-yr clinical outcomes. Further large-scaled trials are needed to confirm the efficacy of this device.
authors.affiliation: Division of Cardiology, SH Ho Cardiovascular and Stroke Centre, Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong Special Administrative Region. yylam@cuhk.edu.hk
authors.forename: Yat-Yin
authors.initials: YY
authors.lastname: Lam
authors.forename: Gabriel W K
authors.initials: GW
authors.lastname: Yip
authors.forename: Cheuk-Man
authors.initials: CM
authors.lastname: Yu
authors.forename: Wilson W M
authors.initials: WW
authors.lastname: Chan
authors.forename: Boron C W
authors.initials: BC
authors.lastname: Cheng
authors.forename: Bryan P
authors.initials: BP
authors.lastname: Yan
authors.forename: Richard
authors.initials: R
authors.lastname: Clugston
authors.forename: Gerald
authors.initials: G
authors.lastname: Yong
authors.forename: Tim
authors.initials: T
authors.lastname: Gattorna
authors.forename: Vincent
authors.initials: V
authors.lastname: Paul
mesh_terms: D000368:Aged; D020517:Atrial Appendage / Q000601:surgery*; D001281:Atrial Fibrillation / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D006328:Cardiac Catheterization / Q000295:instrumentation* / Q000379:methods; D015331:Cohort Studies; D017548:Echocardiography, Transesophageal / Q000379:methods; D005240:Feasibility Studies; D005260:Female; D005471:Fluoroscopy / Q000379:methods; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D055989:Septal Occluder Device; D020521:Stroke / Q000209:etiology / Q000517:prevention & control*; D013997:Time Factors; D016896:Treatment Outcome