title: Experience of left atrial appendage closure performed under conscious sedation.
abstract: BACKGROUND
  Percutaneous left atrial appendage closure is typically performed with transesophageal echocardiography guidance under general anesthesia. This study was performed to investigate the safety, feasibility, procedural characteristics, and outcomes of performing this procedure under conscious sedation without an anesthetist's support.
  
  
  METHODS
  Eleven patients (6 men; mean age 64.6 ± 10.4 years) with atrial fibrillation (median CHA2DS2VASc score 3) underwent transesophageal echocardiography-guided left atrial appendage occlusion under conscious sedation.
  
  
  RESULTS
  All patients had successful procedures. Procedural duration and fluoroscopic times were 93.8 ± 25.3 and 16.2 ± 6.5 min, respectively. The doses of midazolam and fentanyl required were 5.4 ± 1.8 mg and 54.5 ± 27 µg, respectively. No complications arose from conscious sedation. Watchman (mean size 29 ± 5 mm) and Amplatzer Cardiac Plug (mean size 24 ± 4 mm) devices were implanted in 5 and 6 patients, respectively. One patient had device displacement due to over-compression on day one, and underwent successful percutaneous retrieval without any long-term sequelae. Warfarin was stopped in all patients after day 45, with transesophageal echocardiography showing optimal device position without a significant jet flow. In a mean follow-up of 12.1 ± 10.1 months, no thromboembolic complications were observed.
  
  
  CONCLUSIONS
  Percutaneous left atrial appendage occlusion can be performed safely and effectively under conscious sedation. This approach will significantly reduce the complexity and costs of this increasingly performed procedure.
authors.affiliation: Princess Margaret Hospital, Hong Kong ngaiyinchan@yahoo.com.hk.
authors.forename: Ngai-Yin
authors.initials: NY
authors.lastname: Chan
authors.affiliation: Princess Margaret Hospital, Hong Kong.
authors.forename: Chun-Leung
authors.initials: CL
authors.lastname: Lau
authors.affiliation: Princess Margaret Hospital, Hong Kong.
authors.forename: Ping-Tim
authors.initials: PT
authors.lastname: Tsui
authors.affiliation: Princess Margaret Hospital, Hong Kong.
authors.forename: Ying-Keung
authors.initials: YK
authors.lastname: Lo
authors.affiliation: Princess Margaret Hospital, Hong Kong.
authors.forename: Ngai-Shing
authors.initials: NS
authors.lastname: Mok
mesh_terms: D000368:Aged; D020517:Atrial Appendage / Q000000981:diagnostic imaging* / Q000601:surgery*; D001281:Atrial Fibrillation / Q000628:therapy*; D016292:Procedural Sedation / Q000379:methods*; D017548:Echocardiography, Transesophageal; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D055989:Septal Occluder Device; D016896:Treatment Outcome
keywords: Anticoagulants; Atrial fibrillation; conscious sedation; echocardiography; stroke; transesophageal