title: Amplatzer left atrial appendage occlusion: single center 10-year experience.
abstract: OBJECTIVE
  To report a 10-year single center experience with Amplatzer devices for left atrial appendage (LAA) occlusion.
  
  
  BACKGROUND
  Intermediate-term outcome data following LAA occlusion are scarce.
  
  
  METHODS
  Short- and intermediate-term outcomes of patients who underwent LAA occlusion were assessed. All procedures were performed under local aesthesia without transesophageal echocardiography. Patients were discharged on acetylsalicylic acid and clopidogrel for 1-6 months.
  
  
  RESULTS
  LAA occlusion was attempted in 152 patients (105 males, age 72 ± 10 years, CHA2 DS2 -Vasc-score 3.4 ± 1.7, HAS-BLED-score 2.4 ± 1.2). Nondedicated devices were used in 32 patients (21%, ND group) and dedicated Amplatzer Cardiac Plugs were used in 120 patients (79%, ACP group). A patent foramen ovale or atrial septal defect was used for left atrial access and closed at the end of LAA occlusion in 40 patients. The short-term safety endpoints (procedural complications, bleeds) occurred in 15 (9.8%) and the efficacy endpoints (death, stroke, systemic embolization) in 0 patients. Device embolization occurred more frequently in the ND as compared to the ACP group (5 patients or 12% vs. 2 patients or 2%). Mean intermediate-term follow up of the study population was 32 months (range 1-120). Late deaths occurred in 15 patients (5 cardiovascular, 7 noncardiac, 3 unexplained). Neurologic events occurred in 2, peripheral embolism in 1, and major bleeding in 4 patients. The composite efficacy and safety endpoint occurred in 7% and 12% of patients.
  
  
  CONCLUSIONS
  LAA closure may be a good alternative to oral anticoagulation. This hypothesis needs to be tested in a randomized clinical trial to ensure that all potential biases of this observational study are accounted for.
authors: Department of Cardiology, Bern University Hospital, Bern, Switzerland.
authors: Fabian
authors: F
authors: Nietlispach
authors: Steffen
authors: S
authors: Gloekler
authors: René
authors: R
authors: Krause
authors: Samera
authors: S
authors: Shakir
authors: Michael
authors: M
authors: Schmid
authors: Ahmed A
authors: AA
authors: Khattab
authors: Peter
authors: P
authors: Wenaweser
authors: Stephan
authors: S
authors: Windecker
authors: Bernhard
authors: B
authors: Meier
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000772:Anesthesia, Local; D001241:Aspirin / Q000627:therapeutic use; D020517:Atrial Appendage / Q000503:physiopathology*; D001281:Atrial Fibrillation / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D006328:Cardiac Catheterization / Q000009:adverse effects / Q000295:instrumentation*; D000077144:Clopidogrel; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D015641:Radiography, Interventional; D012189:Retrospective Studies; D020521:Stroke / Q000209:etiology / Q000517:prevention & control*; D013557:Switzerland; D013988:Ticlopidine / Q000031:analogs & derivatives / Q000627:therapeutic use; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D010975:Platelet Aggregation Inhibitors; D000077144:Clopidogrel; D013988:Ticlopidine; D001241:Aspirin
keywords: device closure; embolism; interventional closure; left atrial appendage; stroke