title: Left atrial appendage closure followed by 6 weeks of antithrombotic therapy: a prospective single-center experience.
abstract: BACKGROUND
  Currently, 2 different left atrial appendage (LAA) closure systems are available for stroke prevention in nonvalvular atrial fibrillation but comparative data are lacking.
  
  
  OBJECTIVE
  To prospectively compare procedural data and patient outcome for 2 contemporary LAA closure systems and to investigate an alternative antithrombotic treatment regimen in high-risk patients.
  
  
  METHODS
  Patients with nonvalvular atrial fibrillation, with high risk for stroke, and who either had contraindication or were not willing to accept oral anticoagulation were prospectively enrolled. Watchman (Boston Scientific, Natick, MA; group A) or Amplatzer Cardiac Plug (St Jude Medical, Minneapolis, MN; group B) devices were implanted. All patients received antithrombotic therapy for 6 weeks. After repeat transesophageal echocardiography, patients were switched to aspirin.
  
  
  RESULTS
  Eighty patients were enrolled. There was no statistical difference in patient characteristics in groups A and B: CHA2DS2VASC score: 4.1 ± 1.5 versus 4.5 ± 1.8; HASBLED score: 3.1 ± 1.1 versus 3.1 ± 1.1, respectively. LAA closure was achieved in 78 of 80 patients (98%) (group A: 38 of 40 [95%] vs group B: 40 of 40 [100%]). There was no difference in procedure time (group A: 48 ± 16 minutes vs group B: 47 ± 15 minutes; P = .69) and fluoroscopy time (group A: 6.0 ± 4.7 minutes vs group B: 7.3 ± 4.4 minutes; P = .25). Major complications included 1 air embolism and delayed tamponade in each group. After 6 weeks, 1 device dislodgment and 4 device-related thrombi were detected. Ninety-four percent of the patients (73 of 77) were switched to aspirin after 6 weeks. During a median follow-up of 364 days (Q1-Q3: 283-539 days), no systemic embolism occurred, but 3 patients died (heart failure: n = 2; bleeding: n = 1).
  
  
  CONCLUSIONS
  Implantation of both LAA closure devices can be performed with high success rates in high-risk patients. Postprocedural 6 weeks antithrombotic therapy followed by aspirin therapy needs to be confirmed in a larger study.
authors: Medizinische Klinik III, Cardioangiologisches Centrum Bethanien, Markus Krankenhaus, Frankfurt am Main, Germany. Electronic address: j.chun@ccb.de.
authors: K R Julian
authors: KR
authors: Chun
authors: Stefano
authors: S
authors: Bordignon
authors: Verena
authors: V
authors: Urban
authors: Laura
authors: L
authors: Perrotta
authors: Daniela
authors: D
authors: Dugo
authors: Alexander
authors: A
authors: Fürnkranz
authors: Bernd
authors: B
authors: Nowak
authors: Boris
authors: B
authors: Schmidt
mesh_terms: D000368:Aged; D020517:Atrial Appendage / Q000000981:diagnostic imaging*; D001281:Atrial Fibrillation / Q000150:complications / Q000503:physiopathology / Q000628:therapy*; D017548:Echocardiography, Transesophageal; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D011446:Prospective Studies; D020521:Stroke / Q000209:etiology / Q000517:prevention & control*; D013927:Thrombosis / Q000150:complications / Q000188:drug therapy*; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D005343:Fibrinolytic Agents
keywords: ACP; AF; ASA; Amplatzer Cardiac Plug; Atrial fibrillation; DPI; LA; LAA; Left atrial appendage closure; NVAF; OAC; PROTECT-AF; Percutaneous Closure of the Left Atrial Appendage Versus Warfarin Therapy for Prevention of Stroke in Patients With Atrial Fibrillation; Stroke; TEE; TIA; VKA; aspirin; atrial fibrillation; dual platelet inhibition; left atrial appendage; left atrium/atrial; nonvalvular atrial fibrillation; oral anticoagulation; transesophageal echocardiography; transient ischemic attack; vitamin K antagonist