title: Left atrial appendage occlusion in high-risk patients with non-valvular atrial fibrillation.
abstract: Percutaneous left atrial appendage (LAA) occlusion has been developed as a viable option for stroke and thromboembolism prevention in patients with non-valvular atrial fibrillation (NVAF) and at high risk for cerebral cardioembolic events. Data on device implantation and long-term follow-up from large cohorts are limited.
  
  
  
  110 consecutive patients with NVAF and contraindications to oral anticoagulants (OACs) underwent LAA occlusion procedures and achieved a longer than 1 year follow-up. All patients were enrolled in a prospective registry. Procedures were performed using the Amplatzer Cardiac Plug or Amulet guided by fluoroscopy and intracardiac echocardiography.
  
  
  
  Mean age of the population was 77±6 years old; 68 were men. Atrial fibrillation was paroxysmal in 20%, persistent in 15.5% and permanent in 64.5% of cases, respectively. Mean CHA2DS2-VASc and HAS-BLED scores were 4.3±1.3 and 3.4±1, respectively. Technical success (successful deployment and implantation of device) was achieved in 100% of procedures. Procedural success (technical success without major procedure-related complications) was achieved in 96.4%, with a 3.6% rate of major procedural complications (three cases of pericardial tamponade requiring drainage and one case of major bleeding). Mean follow-up was 30±12 months (264 patient-years). Annual rates for ischaemic stroke and for other thromboembolic events were respectively 2.2% and 0%, and annual rate for major bleeding was 1.1%.
  
  
  
  Our data suggest LAA occlusion in high-risk patients with NVAF not suitable for OACs is feasible and associated with low complication rates as well as low rates of stroke and major bleeding at long-term follow-up.
authors: Fondazione Toscana G. Monasterio-Ospedale del Cuore G. Pasquinucci, Massa, Italy.
authors: Sergio
authors: S
authors: Berti
authors: Fondazione Toscana G. Monasterio-Ospedale del Cuore G. Pasquinucci, Massa, Italy.|Scuola Superiore Sant'Anna-Istituto di Scienze della Vita, Pisa, Italy.
authors: Luigi Emilio
authors: LE
authors: Pastormerlo
authors: Fondazione Toscana G. Monasterio-Ospedale del Cuore G. Pasquinucci, Massa, Italy.
authors: Marco
authors: M
authors: Rezzaghi
authors: Fondazione Toscana G. Monasterio-Ospedale del Cuore G. Pasquinucci, Massa, Italy.
authors: Giuseppe
authors: G
authors: Trianni
authors: Fondazione Toscana G. Monasterio-Ospedale del Cuore G. Pasquinucci, Massa, Italy.
authors: Umberto
authors: U
authors: Paradossi
authors: Fondazione Toscana G. Monasterio-Ospedale del Cuore G. Pasquinucci, Massa, Italy.
authors: Elisa
authors: E
authors: Cerone
authors: Fondazione Toscana G. Monasterio-Ospedale del Cuore G. Pasquinucci, Massa, Italy.
authors: Marcello
authors: M
authors: Ravani
authors: Fondazione Toscana G. Monasterio-Ospedale del Cuore G. Pasquinucci, Massa, Italy.
authors: Alberto Ranieri
authors: AR
authors: De Caterina
authors: Fondazione Toscana G. Monasterio-Ospedale del Cuore G. Pasquinucci, Massa, Italy.
authors: Antonio
authors: A
authors: Rizza
authors: Fondazione Toscana G. Monasterio-Ospedale del Cuore G. Pasquinucci, Massa, Italy.
authors: Cataldo
authors: C
authors: Palmieri
mesh_terms: D000284:Administration, Oral; D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000008:administration & dosage; D020517:Atrial Appendage / Q000000981:diagnostic imaging / Q000503:physiopathology; D001281:Atrial Fibrillation / Q000150:complications / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000628:therapy*; D006328:Cardiac Catheterization / Q000009:adverse effects / Q000295:instrumentation; D000075202:Contraindications; D004452:Echocardiography; D005260:Female; D005471:Fluoroscopy; D005500:Follow-Up Studies; D006470:Hemorrhage / Q000209:etiology; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D018579:Patient Selection; D011446:Prospective Studies; D015641:Radiography, Interventional / Q000379:methods; D012042:Registries; D018570:Risk Assessment; D012307:Risk Factors; D020521:Stroke / Q000209:etiology / Q000401:mortality / Q000517:prevention & control*; D013997:Time Factors; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional / Q000379:methods
chemical_list: D000925:Anticoagulants
keywords: Stroke