title: Percutaneous left atrial appendage closure for stroke prevention.
abstract: BACKGROUND
  In atrial fibrillation (AF) patients with an increased stroke risk, oral anticoagulation (OAC) is the standard treatment for stroke prevention. However, this therapy carries a high risk of major bleeding. Percutaneous closure of the left atrial appendage (LAA) is suggested as an alternative option for stroke prevention in AF patients with contraindication(s) for OAC treatment.
  
  
  METHODS
  A total of 42 patients underwent percutaneous LAA closure. In this report, we describe our experience with this procedure.
  
  
  RESULTS
  The patients treated were AF patients with a high stroke risk (CHADS-VASc 4.5±1.4) and contra-indication(s) for OAC and/or a high bleeding risk (HAS-BLED 3.7±0.9). A history of intracerebral bleeding was the most common reason for LAA closure. Successful implantation was obtained in 41 of 42 patients. One major peri-procedural complication occurred; a major gastrointestinal bleeding immediately after the procedure. The mean duration of follow-up was 12.6 months. Both ischaemic stroke and bleeding occurred in one patient, resulting in an observed annual stroke and bleeding rate of 2.3%. This rate was lower than expected based on the CHADS-VASc (5.6%/year) and HAS-BLED (7.6%/year) for the patient cohort. At echo follow-up, incomplete LAA closure was seen in one case; device thrombosis was not observed.
  
  
  CONCLUSIONS
  Our data confirm that percutaneous LAA closure can be a safe and effective strategy for stroke prevention in AF patients with an increased stroke and bleeding risk. However, long-term follow-up studies are needed before this procedure can be recommended for routine clinical use.
  
  
  BACKGROUND
  Grant funding was received (St Jude Medical) for research, but there are no other competing interests.
  
  
  BACKGROUND
  Not relevant.
authors.affiliation: Kardiologisk Afdeling, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen Ø, Denmark. ole.debacker@gmail.com.
authors.forename: Ole
authors.initials: O
authors.lastname: De Backer
authors.forename: Anastasia M
authors.initials: AM
authors.lastname: Loupis
authors.forename: Nikolaj
authors.initials: N
authors.lastname: Ihlemann
authors.forename: Niels G
authors.initials: NG
authors.lastname: Vejlstrup
authors.forename: Lars
authors.initials: L
authors.lastname: Søndergaard
authors.forename: Olaf W
authors.initials: OW
authors.lastname: Franzen
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants; D020517:Atrial Appendage / Q000601:surgery*; D001281:Atrial Fibrillation / Q000188:drug therapy / Q000601:surgery*; D000075202:Contraindications; D005260:Female; D006801:Humans; D008297:Male; D019919:Prosthesis Implantation / Q000009:adverse effects; D055989:Septal Occluder Device; D020521:Stroke / Q000517:prevention & control*
chemical_list: D000925:Anticoagulants