title: Left Atrial Appendage Closure for Atrial Fibrillation Is Safe and Effective After Intracranial or Intraocular Hemorrhage.
abstract: BACKGROUND
  Atrial fibrillation (AF) affects 1%-2% of the general population and 13% of individuals older than 80 years of age. Anticoagulation has been the mainstay therapy to reduce stroke risk. Patients with previous intracranial hemorrhage (ICH) or intraocular hemorrhage (IOH) are at increased risk of recurrence if anticoagulation is continued or initiated. Left atrial appendage (LAA) closure may obviate the need for long-term anticoagulation in these patients.
  
  
  METHODS
  We report our consecutive series of patients with nonvalvular AF with previous ICH or IOH who underwent LAA closure with the AMPLATZER Cardiac Plug (ACP; St Jude Medical, St Paul, MN), AMPLATZER Amulet, or WATCHMAN (Boston Scientific, Natick, MA) device. Demographics, clinical status, procedural outcomes, and complications were collected at baseline, during the procedure, at 3 months, at 1 year, and annually thereafter.
  
  
  RESULTS
  Twenty-six patients with previous ICH (n = 24) or IOH (n = 2) underwent LAA closure (9 with the ACP, 3 with the Amulet, and 7 with the WATCHMAN). The mean age was 76 ± 7 years, and 61.5% were men with a mean CHADS2 (Congestive Heart Failure, Hypertension, Age, Diabetes, Stroke/Transient Ischemic Attack) score of 3.2 ± 1.4 and CHA2DS2-VASc (Congestive Heart Failure, Hypertension, Age [≥ 75 years], Diabetes, Stroke/Transient Ischemic Attack, Vascular Disease, Age [65-74 years], Sex [Female] score) of 4.9 ± 1.7. No procedure-related complications occurred. Mean follow-up was 11.9 ± 13.3 months. One patient died at 13 months (this death was not related to the procedure), and 1 patient had a transient ischemic attack at 20.6 months after the procedure. No ischemic stroke, haemorrhagic stroke, or bleeding problems occurred during follow-up.
  
  
  CONCLUSIONS
  In our consecutive series, LAA closure was found to be safe and effective in patients with AF and a history of ICH or IOH.
authors.affiliation: Division of Cardiology, Vancouver General Hospital, University of British Columbia, British Columbia, Canada.
authors.forename: Peter
authors.initials: P
authors.lastname: Fahmy
authors.affiliation: Division of Cardiology, Vancouver General Hospital, University of British Columbia, British Columbia, Canada.
authors.forename: Ryan
authors.initials: R
authors.lastname: Spencer
authors.affiliation: Division of Cardiology, Vancouver General Hospital, University of British Columbia, British Columbia, Canada.
authors.forename: Michael
authors.initials: M
authors.lastname: Tsang
authors.affiliation: Division of Neurosurgery, Vancouver General Hospital, University of British Columbia, British Columbia, Canada.
authors.forename: Peter
authors.initials: P
authors.lastname: Gooderham
authors.affiliation: Division of Cardiology, Vancouver General Hospital, University of British Columbia, British Columbia, Canada. Electronic address: jsaw@mail.ubc.ca.
authors.forename: Jacqueline
authors.initials: J
authors.lastname: Saw
mesh_terms: D000368:Aged; D020517:Atrial Appendage / Q000000981:diagnostic imaging / Q000601:surgery*; D001281:Atrial Fibrillation / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D001955:British Columbia / Q000453:epidemiology; D006348:Cardiac Surgical Procedures / Q000379:methods*; D017548:Echocardiography, Transesophageal; D005130:Eye Hemorrhage / Q000209:etiology / Q000517:prevention & control*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D020300:Intracranial Hemorrhages / Q000209:etiology / Q000517:prevention & control*; D008297:Male; D015996:Survival Rate / Q000639:trends; D016896:Treatment Outcome