title: Percutaneous closure of the left atrial appendage for secondary prevention of stroke in patients with atrial fibrillation and contraindications to chronic anticoagulant therapy.
abstract: BACKGROUND
  Stroke accounts for approx. 90% of thromboembolic complications associated with atrial fibrillation. The use of oral anticoagulants is the most effective therapy but is associated with risk of haemorrhagic complications.
  
  
  OBJECTIVE
  In this article, we describe a series of patients with atrial fibrillation, cardiogenic stroke history, and contraindications for long-term anticoagulant therapy, in whom an alternative method - percutaneous closure of the left atrial appendage - was performed.
  
  
  METHODS
  Nine patients with atrial fibrillation and previous stroke were qualified for percutaneous closure of the left atrial appendage (5 men and 4 women, aged 45-78 years). Physical and neurological examinations were conducted in the qualification period, 1-3 days before the intervention, and 1-3 days and 1, 3, 6, 12, and 24 months following percutaneous closure of the left atrial appendage. Transoesophageal echocardiography was carried out in the qualification period, 1-3 days before the intervention, and at 1-3 days and 3 and 6 months following the procedure.
  
  
  RESULTS
  No complications were observed in the perioperative period and during the follow-up period of 16-31 months. Echocardiographic examinations showed that occluders were present in the appropriate positions.
  
  
  CONCLUSIONS
  Percutaneous closure of the left atrial appendage can be an alternative form of secondary prevention of stroke in patients with atrial fibrillation and contraindications for long-term anticoagulant therapy or those who have problems managing drug treatment. Complex clinical assessment performed by a neuro-cardiac team allows safe and efficient invasive treatment.
authors.affiliation: Department of Neurology, Medical University of Silesia, Hospital No. 7, Professor Leszek Giec Upper Silesian Medical Centre, Katowice, Poland.
authors.forename: Anetta
authors.initials: A
authors.lastname: Lasek-Bal
authors.affiliation: 1 Department of Cardiology, Medical University of Silesia, Hospital No. 7, Professor Leszek Giec Upper Silesian Medical Centre, Katowice, Poland.
authors.forename: Katarzyna
authors.initials: K
authors.lastname: Mizia-Stec
keywords: atrial appendage; atrial fibrillation; stroke
references.citation: J Am Coll Cardiol. 2014 Jul 8;64(1):1-12
references.pmid: 24998121
references.citation: J Thromb Thrombolysis. 2014 Jul;38(1):39-44
references.pmid: 24197653
references.citation: Catheter Cardiovasc Interv. 2014 Apr 1;83(5):805-10
references.pmid: 24259397
references.citation: Circulation. 2011 Feb 1;123(4):417-24
references.pmid: 21242484
references.citation: Stroke. 2006 Apr;37(4):1075-80
references.pmid: 16527999
references.citation: J Am Coll Cardiol. 2005 Nov 1;46(9):1729-36
references.pmid: 16256877
references.citation: Heart Lung Circ. 2013 Jan;22(1):50-5
references.pmid: 23058974
references.citation: JAMA. 2001 Jun 13;285(22):2864-70
references.pmid: 11401607
references.citation: BMJ. 2006 Jan 21;332(7534):141-5
references.pmid: 16403771
references.citation: Catheter Cardiovasc Interv. 2011 Apr 1;77(5):700-6
references.pmid: 20824765
references.citation: Chest. 2003 Dec;124(6):2356-62
references.pmid: 14665520
references.citation: Lancet. 2009 Aug 15;374(9689):534-42
references.pmid: 19683639
references.citation: J Am Coll Cardiol. 2013 Jun 25;61(25):2551-6
references.pmid: 23583249
references.citation: Circulation. 2013 Feb 12;127(6):720-9
references.pmid: 23325525
references.citation: Am J Cardiol. 1994 Aug 1;74(3):236-41
references.pmid: 8037127
references.citation: Chest. 2006 May;129(5):1155-66
references.pmid: 16685005
references.citation: Heart. 2004 Jul;90(7):813-7
references.pmid: 15201261
references.citation: Kardiol Pol. 2010 Feb;68(2):250-4
references.pmid: 20301041
references.citation: Kardiol Pol. 2013;71(1):8-16
references.pmid: 23348528
references.citation: Stroke. 1991 Aug;22(8):983-8
references.pmid: 1866765
references.citation: Eur Heart J. 2012 Nov;33(21):2719-47
references.pmid: 22922413
references.citation: Stroke. 2011 Jan;42(1):227-76
references.pmid: 20966421
references.citation: Circulation. 2009 Nov 10;120(19):1919-26; discussion 1926
references.pmid: 19901202
references.citation: JAMA. 2001 May 9;285(18):2370-5
references.pmid: 11343485