title: Ad hoc percutaneous left atrial appendage closure.
abstract: OBJECTIVE
  To investigate the feasibility of ad hoc left atrial appendage (LAA) closure in patients in atrial fibrillation.
  
  
  BACKGROUND
  Feasibility of ad hoc LAA closure depends, among other things, on transesophageal echocardiography (TEE) being omittable.
  
  
  METHODS
  Patients underwent ad hoc LAA closure at the same sitting as coronary angiography. TEE guidance or sedation was omitted. Left atrial access was via coexisting patent foramen ovale (PFO) or a transseptal puncture. Arriving in the left atrium, a contrast medium injection was performed, avoiding LAA intubation to exclude thrombus in the LAA. Thereafter, the 13 Fr TorqVue delivery sheath (the largest one available and compatible with all occluders) was advanced into the LAA and the diameter of the landing zone was estimated using the outer diameter of the sheath as a reference. An accordingly selected Amplatzer Cardiac Plug was deployed in the LAA.
  
  
  RESULTS
  Median CHA2DS2-VASc score of the 13 included patients (8 males; age 76 years; interquartile range [IQR], 68-84 years) was 5 (IQR, 3-5) and HAS-BLED score was 3 (IQR, 2-4). Contrast medium injection to the left atrium did not reveal a thrombus in the LAA in any patient. The LAA closure procedures were uneventful and follow-up transthoracic echocardiography before discharge confirmed correct device position. Patients were discharged on acetylsalicylic acid and clopidogrel without vitamin-K antagonists.
  
  
  CONCLUSIONS
  Ad hoc LAA closure using local anesthesia and fluoroscopy alone appears feasible.
authors.affiliation: Swiss Cardiovascular Center Bern, Bern University Hospital, 3010 Bern, Switzerland. bernhard.meier@insel.ch.
authors.forename: Fabian
authors.initials: F
authors.lastname: Nietlispach
authors.forename: René
authors.initials: R
authors.lastname: Krause
authors.forename: Ahmed
authors.initials: A
authors.lastname: Khattab
authors.forename: Steffen
authors.initials: S
authors.lastname: Gloekler
authors.forename: Michael
authors.initials: M
authors.lastname: Schmid
authors.forename: Peter
authors.initials: P
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 / Q000000981:diagnostic imaging; D001281:Atrial Fibrillation / Q000000981:diagnostic imaging / Q000628:therapy*; D017548:Echocardiography, Transesophageal; D005240:Feasibility Studies; D005260:Female; D005471:Fluoroscopy; D005500:Follow-Up Studies; D006325:Heart Atria / Q000000981:diagnostic imaging; D006801:Humans; D008297:Male; D062645:Percutaneous Coronary Intervention / Q000379:methods*; D012189:Retrospective Studies; D055989:Septal Occluder Device; D020521:Stroke / Q000517:prevention & control; D016896:Treatment Outcome