title: Left atrial appendage closure with the Amplatzer cardiac plug in patients with atrial fibrillation.
abstract: BACKGROUND
  Percutaneous left atrial appendage closure (LAAC) has emerged as an alternative to oral anticoagulation (OA) for prevention of thromboembolic stroke in patients with non-valvular atrial fibrillation (NVAF).
  
  
  OBJECTIVE
  To describe the immediate results and short- to medium-term clinical follow-up (FU) of patients that underwent LAAC with Amplatzer Cardiac Plug (ACP) implantation in a single reference center.
  
  
  METHODS
  Eighty-six consecutive patients with NVAF, contraindication to OA, and CHADS2 score=2.6 ± 1.2 underwent LAAC with ACP implantation. Clinical and echocardiographic FU was performed at least four months after the procedure.
  
  
  RESULTS
  All implants were guided by angiography alone. Procedural success was 99% (one patient suffered a cardiac tamponade requiring pericardiocentesis, and the procedure was waived). There were four major complications (the already mentioned cardiac tamponade, two transient ischemic attacks and one device embolization with percutaneous retrieval) and two minor complications (one pericardial effusion without clinical significance and one non-significant ASD evidenced at FU). There was one in-hospital death after six days, unrelated to the procedure. All other patients were discharged without OA. After 25.9 patient-years of FU (69 patients), there were no strokes and no late device embolization. The LAA was completely closed in 97% of the cases. Six patients showed evidence of thrombus formation on the device, which resolved after three months of OA.
  
  
  CONCLUSIONS
  LAAC is associated with high success, acceptable complication rates, and promising FU results, and may be considered a valuable alternative or complement to OA for stroke prevention in patients with NVAF.
authors.affiliation: Cardiovascular Department, University Hospital Bern, Berna, Suíça.
authors.forename: Enio Eduardo
authors.initials: EE
authors.lastname: Guérios
authors.forename: Michael
authors.initials: M
authors.lastname: Schmid
authors.forename: Steffen
authors.initials: S
authors.lastname: Gloekler
authors.forename: Ahmed A
authors.initials: AA
authors.lastname: Khattab
authors.forename: Peter M
authors.initials: PM
authors.lastname: Wenaweser
authors.forename: Stephan
authors.initials: S
authors.lastname: Windecker
authors.forename: Bernhard
authors.initials: B
authors.lastname: Meier
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D020517:Atrial Appendage / Q000601:surgery*; D001281:Atrial Fibrillation / Q000517:prevention & control*; D006328:Cardiac Catheterization / Q000295:instrumentation / Q000379:methods; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011474:Prosthesis Design; D012307:Risk Factors; D055989:Septal Occluder Device / Q000009:adverse effects / Q000592:standards; D016896:Treatment Outcome