title: Percutaneous occlusion of left atrial appendage with the Amplatzer Cardiac PlugTM in atrial fibrillation.
abstract: BACKGROUND
  Atrial fibrillation is associated with embolic strokes that often result in death or disability. Effective in reducing these events, anticoagulation has several limitations and has been widely underutilized. Over 90% of thrombi identified in patients with atrial fibrillation without valvular disease originate in the left atrial appendage, whose occlusion is investigated as an alternative to anticoagulation.
  
  
  OBJECTIVE
  To determine the feasibility of percutaneous occlusion of the left atrial appendage in patients at high risk of embolic events and limitations to the use of anticoagulation.
  
  
  METHODS
  We report our initial experience with Amplatzer Cardiac Plug™ (St. Jude Medical Inc., Saint Paul, Estados Unidos) in patients with nonvalvular atrial fibrillation. We selected patients at high risk of thromboembolism, major bleeding, contraindications to the use or major instability in response to the anticoagulant. The procedures were performed percutaneously under general anesthesia and transesophageal echocardiography. The primary outcome was the presence of periprocedural complications and follow-up program included clinical and echocardiographic review within 30 days and by telephone contact after nine months.
  
  
  RESULTS
  In five selected patients it was possible to occlude the left atrial appendage without periprocedural complications. There were no clinical events in follow-up.
  
  
  CONCLUSIONS
  Controlled clinical trials are needed before percutaneous closure of the left atrial appendage should be considered an alternative to anticoagulation in nonvalvular atrial fibrillation. But the device has shown to be promissory in patients at high risk of embolism and restrictions on the use of anticoagulants.
authors.affiliation: Instituto Estadual de Cardiologia Aloysio de Castro, Rio de Janeiro, Brasil. marciojmontenegro@hotmail.com
authors.forename: Márcio José
authors.initials: MJ
authors.lastname: Montenegro
authors.forename: Edgard Freitas
authors.initials: EF
authors.lastname: Quintella
authors.forename: Aníbal
authors.initials: A
authors.lastname: Damonte
authors.forename: Hugo de Castro
authors.initials: Hde C
authors.lastname: Sabino
authors.forename: Ricardo
authors.initials: R
authors.lastname: Zajdenverg
authors.forename: Gustavo Pinaud
authors.initials: GP
authors.lastname: Laufer
authors.forename: Bernardo
authors.initials: B
authors.lastname: Amorim
authors.forename: André Pereira Duque
authors.initials: AP
authors.lastname: Estrada
authors.forename: Cristian Paul Yugcha
authors.initials: CP
authors.lastname: Armas
authors.forename: Aline
authors.initials: A
authors.lastname: Sterque
mesh_terms: D000368:Aged; D000925:Anticoagulants; D020517:Atrial Appendage; D001281:Atrial Fibrillation / Q000000981:diagnostic imaging / Q000628:therapy*; D000075202:Contraindications; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D020766:Intracranial Embolism / Q000517:prevention & control*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D055989:Septal Occluder Device / Q000009:adverse effects; D020521:Stroke / Q000517:prevention & control*; D016896:Treatment Outcome; D014463:Ultrasonography
chemical_list: D000925:Anticoagulants