title: Double device left atrial appendage closure.
abstract: OBJECTIVE
  Percutaneous left atrial appendage (LAA) occlusion is an alternative to oral anticoagulation for the prevention of stroke in patients with non-valvular atrial fibrillation (NVAF). Due to the great anatomic variability of the LAA, complete closure may not always be obtained with a single device. We report cases in which adequate closure of the LAA was achieved with implantation of two devices.
  
  
  RESULTS
  Five out of 223 consecutive patients who underwent LAA occlusion without guidance with transoesophageal echocardiography (TOE) had a second device implanted to treat significant residual leaks or uncovered parts of the LAA after first device implantation. All procedures were successful, with no complications. Two patients received two AMPLATZER Cardiac Plugs (ACP); one patient received one ACP and one AMPLATZER Vascular Plug; one patient received one AMPLATZER Septal Occluder (ASO) and one ACP prototype; and one patient received two ASOs. TOE performed at least four months after the procedure showed complete closure of the LAA in all patients, without thrombus formation on the devices. After 14 patient-years there were no strokes, peripheral thromboemboli, or device embolisations.
  
  
  CONCLUSIONS
  When necessary, the implantation of two devices to achieve complete LAA occlusion in patients with NVAF is feasible and leads to favourable results during follow-up. Potentially, this technical innovation may widen LAA occlusion indications by permitting occlusion of LAAs with large ostia or complex anatomy.
authors.affiliation: Department of Cardiology, Bern University Hospital, Bern, Switzerland.
authors.forename: Ênio E
authors.initials: ÊE
authors.lastname: Guérios
authors.forename: Steffen
authors.initials: S
authors.lastname: Gloekler
authors.forename: Michael
authors.initials: M
authors.lastname: Schmid
authors.forename: Ahmed
authors.initials: A
authors.lastname: Khattab
authors.forename: Fabian
authors.initials: F
authors.lastname: Nietlispach
authors.forename: Bernhard
authors.initials: B
authors.lastname: Meier
mesh_terms: D000368:Aged; D020517:Atrial Appendage / Q000000981:diagnostic imaging / Q000503:physiopathology*; D001281:Atrial Fibrillation / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D006328:Cardiac Catheterization / Q000009:adverse effects / Q000295:instrumentation*; D019560:Echocardiography, Three-Dimensional; D017548:Echocardiography, Transesophageal; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011474:Prosthesis Design; D011859:Radiography; D055989:Septal Occluder Device; D016896:Treatment Outcome