title: Percutaneous closure of the left atrial appendage for prevention of thromboembolism in atrial fibrillation for patients with contraindication to or failure of oral anticoagulation: a single-center experience.
abstract: BACKGROUND
  In non-valvular atrial fibrillation 90% of thrombi originate in the left atrial appendage (LAA). Percutaneous LAA closure has been shown to be non-inferior to warfarin for prevention of thromboembolism.
  
  
  OBJECTIVE
  To evaluate the initial experience of a single center in percutaneous LAA closure in patients with high thromboembolic risk and in whom oral anticoagulation was impractical or contraindicated or had failed.
  
  
  METHODS
  Patients with non-valvular atrial fibrillation and CHADS2 score ≥2 in whom oral anticoagulation was impractical or contraindicated or had failed underwent percutaneous LAA closure according to the standard technique. After the procedure, dual antiplatelet therapy was maintained for one month, followed by single antiplatelet therapy indefinitely. Patients were followed by clinical assessment and transthoracic and transesophageal echocardiography.
  
  
  RESULTS
  The procedure was performed in 22 of the 23 selected patients (95.7%), mean age 70±9 years, CHADS2 score 3.2±0.9 and CHA2DS2-VASC score 4.7±1.4. Intraprocedural device replacement was necessary only in the first patient, due to oversizing. The following periprocedural complications were observed: one femoral pseudoaneurysm, three femoral hematomas and two minor oropharyngeal bleeds, resolved by local hemostatic measures. During a 12±8 month follow-up a mild peri-device flow and a thrombus adhering to the device, resolved under with enoxaparin therapy, were identified. The rate of transient ischemic attack (TIA)/stroke was lower than expected according to the CHADS2 score (0 vs. 6.7±2.2%).
  
  
  CONCLUSIONS
  In our initial experience, this procedure proved to be a feasible, safe and effective alternative for atrial fibrillation patients in whom oral anticoagulation is not an option. Only relatively minor complications were observed, with a lower than expected TIA/stroke rate.
authors: Serviço de Cardiologia, Centro Hospitalar e Universitário de Coimbra - Hospital Geral, Coimbra, Portugal. anacatarina.faustino@gmail.com
authors: Ana
authors: A
authors: Faustino
authors: Luís
authors: L
authors: Paiva
authors: Rui
authors: R
authors: Providência
authors: Joana
authors: J
authors: Trigo
authors: Ana
authors: A
authors: Botelho
authors: Marco
authors: M
authors: Costa
authors: António
authors: A
authors: Leitão-Marques
mesh_terms: D000284:Administration, Oral; D000368:Aged; D000925:Anticoagulants / Q000627:therapeutic use; D020517:Atrial Appendage / Q000601:surgery*; D001281:Atrial Fibrillation / Q000150:complications*; D006348:Cardiac Surgical Procedures / Q000295:instrumentation / Q000379:methods; D000075202:Contraindications; D005260:Female; D006801:Humans; D008297:Male; D011474:Prosthesis Design; D055989:Septal Occluder Device; D013923:Thromboembolism / Q000209:etiology* / Q000517:prevention & control*; D017211:Treatment Failure
chemical_list: D000925:Anticoagulants
keywords: Acidente vascular cerebral; Anticoagulação oral; Apêndice auricular esquerdo; Atrial fibrillation; Cardiac implant; Fibrilhação auricular; Implante cardíaco; Left atrial appendage; Oral anticoagulation; Stroke; Thromboembolism; Tromboembolismo