title: Left atrial appendage occlusion in atrial fibrillation after intracranial hemorrhage.
abstract: OBJECTIVE
  To evaluate the safety and feasibility of percutaneous left atrial appendage occlusion (LAAO) in patients with atrial fibrillation (AF) and previous intracranial hemorrhage (ICH).
  
  
  METHODS
  In an explorative, prospective, single-center, observational study, LAAO was performed in patients with previous ICH and AF using the Amplatzer Cardiac Plug device. Risks of ischemic strokes and hemorrhagic complications were estimated using the CHA2DS2Vasc score and the HAS-BLED score. Before and 1, 6, 12, and 24 months after the procedure, clinical status and complications were recorded. Major complications were predefined as periprocedural stroke, death, pericardial effusion, and device embolism.
  
  
  RESULTS
  LAAO was performed in 20 patients. Based on CHA2DS2Vasc score (mean 4.5 ± 1.4) and HAS-BLED score (mean 4.7 ± 1.0), annual risks of stroke and hemorrhagic complications were 4.0%-6.7% and 8.7%-12.5%, respectively. No patient had a procedure-related complication. Minor postprocedural complications were observed in 4/20 patients (2 inguinal hematoma, 1 self-limiting asystole, and 1 thrombus formation on device). No ischemic or hemorrhagic stroke occurred during a mean follow-up of 13.6 ± 8.2 months.
  
  
  CONCLUSIONS
  In this first study of LAAO in patients with previous ICH, LAAO appears feasible and safe. A larger, controlled trial is needed to assess the efficacy and safety of the procedure compared to other preventive measures.
  
  
  METHODS
  This study provides Class III evidence that in patients with a history of previous ICH and AF, percutaneous LAAO is safe and feasible.
authors: From the Department of Neurology (S.H., T.R., R.V.), Department of Cardiology (C.Z., U.K., N.G., S.H.), and Institute of Medical Biometry and Informatics (G.R.), University of Heidelberg, Germany.
authors: Solveig
authors: S
authors: Horstmann
authors: Christian
authors: C
authors: Zugck
authors: Ulrike
authors: U
authors: Krumsdorf
authors: Timolaos
authors: T
authors: Rizos
authors: Geraldine
authors: G
authors: Rauch
authors: Nicolas
authors: N
authors: Geis
authors: Stefan
authors: S
authors: Hardt
authors: Roland
authors: R
authors: Veltkamp
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D020517:Atrial Appendage / Q000601:surgery*; D001281:Atrial Fibrillation / Q000209:etiology / Q000601:surgery*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D020300:Intracranial Hemorrhages / Q000150:complications / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology / Q000628:therapy; D011446:Prospective Studies; D020521:Stroke / Q000209:etiology; D060205:Therapeutic Occlusion / Q000009:adverse effects / Q000379:methods*; D016896:Treatment Outcome