title: Predictors of Early (1-Week) Outcomes Following Left Atrial Appendage Closure With Amplatzer Devices.
abstract: The aim of this study was to assess predictors of adverse 1-week outcomes and determine the effect of left atrial appendage (LAA) morphology following LAA closure (LAAC) with Amplatzer devices.
  
  
  
  Percutaneous LAAC is a valuable treatment option for stroke prevention in patients with atrial fibrillation. Determinants of procedural safety events with Amplatzer occluders are not well established, and the possibly interrelating effect of LAA anatomy is unknown.
  
  
  
  Between 2009 and 2014, 500 consecutive patients with atrial fibrillation ineligible or at high risk for oral anticoagulation underwent LAAC using Amplatzer devices. Procedure- and device-related major adverse events (MAEs) were defined as the composite of death, stroke, major or life-threatening bleeding, serious pericardial effusion, device embolization, major access-site vascular complication, or need for cardiovascular surgery within 7 days following the intervention.
  
  
  
  Patients (mean age 73.9 ± 10.1 years) were treated with Amplatzer Cardiac Plug (n = 408 [82%]) or Amulet (n = 92 [18%]) devices. Early procedural success was 97.8%, and MAEs occurred in 29 patients (5.8%). Independent predictors of MAEs included device repositioning (odds ratio: 9.13; 95% confidence interval: 2.85 to 33.54; p < 0.001) and left ventricular ejection fraction <30% (odds ratio: 4.08; 95% confidence interval: 1.49 to 11.20; p = 0.006), with no effect of device type or size. Angiographic LAA morphology, characterized as cauliflower (33%), cactus (32%), windsock (20%), or chicken wing (15%), was not associated with procedural success (p = 0.51) or the occurrence of MAEs (p = 0.78).
  
  
  
  In this nonrandomized study, procedural success of LAAC using Amplatzer devices was high. MAEs within 7 days were predicted by patient- and procedure-related factors. Although LAA morphology displayed substantial heterogeneity, outcomes were comparable across the spectrum of LAA anatomies.
authors.affiliation: Cardiology, Cardiovascular Department, University Hospital of Bern, Bern, Switzerland.
authors.forename: Konstantinos C
authors.initials: KC
authors.lastname: Koskinas
authors.affiliation: Cardiology, Cardiovascular Department, University Hospital of Bern, Bern, Switzerland.
authors.forename: Samera
authors.initials: S
authors.lastname: Shakir
authors.affiliation: Cardiology, Cardiovascular Department, University Hospital of Bern, Bern, Switzerland.
authors.forename: Máté
authors.initials: M
authors.lastname: Fankhauser
authors.affiliation: Cardiology, University Hospital of Zurich, Zurich, Switzerland.
authors.forename: Fabian
authors.initials: F
authors.lastname: Nietlispach
authors.affiliation: Cardiology, University Hospital of Zurich, Zurich, Switzerland.
authors.forename: Adrian
authors.initials: A
authors.lastname: Attinger-Toller
authors.affiliation: Cardiology, Cardiovascular Department, University Hospital of Bern, Bern, Switzerland.
authors.forename: Aris
authors.initials: A
authors.lastname: Moschovitis
authors.affiliation: Cardiology, Cardiovascular Department, University Hospital of Bern, Bern, Switzerland.
authors.forename: Peter
authors.initials: P
authors.lastname: Wenaweser
authors.affiliation: Cardiology, Cardiovascular Department, University Hospital of Bern, Bern, Switzerland.
authors.forename: Thomas
authors.initials: T
authors.lastname: Pilgrim
authors.affiliation: Cardiology, Cardiovascular Department, University Hospital of Bern, Bern, Switzerland.
authors.forename: Stefan
authors.initials: S
authors.lastname: Stortecky
authors.affiliation: Cardiology, Cardiovascular Department, University Hospital of Bern, Bern, Switzerland.
authors.forename: Fabien
authors.initials: F
authors.lastname: Praz
authors.affiliation: Cardiology, Cardiovascular Department, University Hospital of Bern, Bern, Switzerland.
authors.forename: Lorenz
authors.initials: L
authors.lastname: Räber
authors.affiliation: Cardiology, Cardiovascular Department, University Hospital of Bern, Bern, Switzerland.
authors.forename: Stephan
authors.initials: S
authors.lastname: Windecker
authors.affiliation: Cardiology, Cardiovascular Department, University Hospital of Bern, Bern, Switzerland.
authors.forename: Bernhard
authors.initials: B
authors.lastname: Meier
authors.affiliation: Cardiology, Cardiovascular Department, University Hospital of Bern, Bern, Switzerland. Electronic address: steffen.gloekler@insel.ch.
authors.forename: Steffen
authors.initials: S
authors.lastname: Gloekler
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D020517:Atrial Appendage / Q000000981:diagnostic imaging / Q000503:physiopathology; D001281:Atrial Fibrillation / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D016279:Atrial Function, Left; D006328:Cardiac Catheterization / Q000009:adverse effects / Q000295:instrumentation*; D016009:Chi-Square Distribution; D017023:Coronary Angiography; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D011474:Prosthesis Design; D012042:Registries; D012189:Retrospective Studies; D012307:Risk Factors; D055989:Septal Occluder Device; D013318:Stroke Volume; D013557:Switzerland; D013997:Time Factors; D016896:Treatment Outcome; D016277:Ventricular Function, Left
keywords: atrial fibrillation; complications; left atrial appendage closure; safety