title: Early experience using a left atrial appendage occlusion device in patients with atrial fibrillation.
abstract: OBJECTIVE
  Atrial fibrillation (AF) is one of the major risk factors for ischemic stroke, and 90% of thromboembolisms in these patients arise from the left atrial appendage (LAA). Recently, it has been documented that an LAA occlusion device (OD) is not inferior to warfarin therapy, and that it reduces mortality and risk of stroke in patients with AF.
  
  
  METHODS
  We implanted LAA-ODs in 5 Korean patients (all male, 59.8 ± 7.3 years old) with long-standing persistent AF or permanent AF via a percutaneous trans-septal approach.
  
  
  RESULTS
  1) The major reasons for LAA-OD implantation were high risk of recurrent stroke (80%), labile international neutralizing ratio with hemorrhage (60%), and 3/5 (60%) patients had a past history of failed cardioversion for rhythm control. 2) The mean LA size was 51.3 ± 5.0 mm and LAA size was 25.1 × 30.1 mm. We implanted the LAA-OD (28.8 ± 3.4 mm device) successfully in all 5 patients with no complications. 3) After eight weeks of anticoagulation, all patients switched from warfarin to anti-platelet agent after confirmation of successful LAA occlusion by trans-esophageal echocardiography.
  
  
  CONCLUSIONS
  We report on our early experience with LAA-OD deployment in patients with 1) persistent or permanent AF who cannot tolerate anticoagulation despite significant risk of ischemic stroke, or 2) recurrent stroke in patients who are unable to maintain sinus rhythm.
authors.affiliation: Department of Cardiology, Yonsei University Health System, Seoul, Korea.
authors.forename: Yung Ly
authors.initials: YL
authors.lastname: Kim
authors.forename: Boyoung
authors.initials: B
authors.lastname: Joung
authors.forename: Young Keun
authors.initials: YK
authors.lastname: On
authors.forename: Chi Young
authors.initials: CY
authors.lastname: Shim
authors.forename: Moon Hyoung
authors.initials: MH
authors.lastname: Lee
authors.forename: Young-Hoon
authors.initials: YH
authors.lastname: Kim
authors.forename: Hui-Nam
authors.initials: HN
authors.lastname: Pak
mesh_terms: D000368:Aged; D000925:Anticoagulants; D020517:Atrial Appendage / Q000503:physiopathology*; D001281:Atrial Fibrillation / Q000453:epidemiology / Q000503:physiopathology* / Q000601:surgery*; D000075202:Contraindications; D006801:Humans; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D055989:Septal Occluder Device; D020521:Stroke / Q000453:epidemiology / Q000517:prevention & control*; D016896:Treatment Outcome; D014859:Warfarin
chemical_list: D000925:Anticoagulants; D014859:Warfarin