title: Does left atrial appendage closure with a cardiac plug system reduce the stroke risk in nonvalvular atrial fibrillation patients? A single-center case series.
abstract: BACKGROUND
  Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia and it is associated with an increased stroke risk, due mainly to cardiac embolism from the left atrial appendage (LAA). Percutaneous LAA closure is a method to reduce stroke risk in AF without using anticoagulant agents. In this study we report data from an Italian experience with the LAA occluder Amplatzer Cardiac Plug (ACP) device (Aga Medical Corporation, Plymouth, MN, USA).
  
  
  METHODS
  The study was designed to evaluate the safety of LAA closure using ACP and the efficacy of the procedure in preventing strokes during a 1-year follow-up. Patients with permanent or paroxysmal AF, high stroke risk, and contraindication to warfarin therapy were selected for the procedure.
  
  
  RESULTS
  The LAA closure was attempted in 37 patients and succeeded in 34 cases (91.9%). Four patients experienced serious complications (one cardiac tamponade requiring pericardiocentesis, two device embolizations, one low-rate response AF requiring artificial pacing). During a 1-year follow-up, ischemic stroke occurred in one of 34 patients, resulting in a stroke rate of 2.94%; thus there was a stroke rate reduction of 50.2% and 26.5% compared to the expected stroke rate, according to CHADS2 and CHA2 DS2 VASc score. None of the patients who received ACP experienced major bleeding during the follow-up.
  
  
  CONCLUSIONS
  LAA closure using ACP is a relatively feasible procedure which can be performed by highly experienced operators to reduce stroke rate in patients with AF, high stroke risk, and contraindication to oral anticoagulants.
authors.affiliation: Cardiology Department, Luigi Sacco Hospital, Milan, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Danna
authors.forename: Riccardo
authors.initials: R
authors.lastname: Proietti
authors.forename: Antonio
authors.initials: A
authors.lastname: Sagone
authors.forename: Andrea
authors.initials: A
authors.lastname: Arensi
authors.forename: Maurizio
authors.initials: M
authors.lastname: Viecca
authors.forename: Anna
authors.initials: A
authors.lastname: Rago
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Russo
mesh_terms: D000368:Aged; D020517:Atrial Appendage / Q000601:surgery*; D001281:Atrial Fibrillation / Q000150:complications*; D005260:Female; D006801:Humans; D008297:Male; D012307:Risk Factors; D055989:Septal Occluder Device; D020521:Stroke / Q000209:etiology* / Q000517:prevention & control*