title: Percutaneous left atrial appendage occlusion using different technologies in the United Kingdom: A multicenter registry.
abstract: OBJECTIVE
  This study aimed at assessing the feasibility and long-term efficacy of left atrial appendage occlusion (LAAO) in a "real world" setting.
  
  
  BACKGROUND
  Although LAAO has recently emerged as an alternative to oral anticoagulants in patients with atrial fibrillation for the prevention of thromboembolic stroke, "real world" data about the procedure with different devices are lacking.
  
  
  METHODS
  Eight centers in the United Kingdom contributed to a retrospective registry for LAAO procedures undertaken between July 2009 and November 2014.
  
  
  RESULTS
  A total of 371 patients (72.9 ± 8.3 years old, 88.9% males) were enrolled. The overall procedure success was 92.5%, with major events in 3.5% of cases. The device choice was Watchman in 63% of cases, Amplatzer Cardiac Plug in 34.7%, Lariat in 1.7%, and Coherex WaveCrest in 0.6%. A significant improvement in procedure success (from 89.2% to 95.7%; P = 0.018) and reduction of acute major complications (from 6.5% to 0.5%; P = 0.001) were observed between procedures in the first and the second half of the recruitment time. An annual 90.1% relative risk reduction (RRR) for ischemic stroke, an 87.2% thromboembolic events RRR, and a 92.9% major bleeding RRR were observed, if compared with the predicted annual risks based on CHADS2, CHA2DS2-Vasc, and HAS-BLED scores, respectively, over a follow-up period of 24.7 ± 16.07 months.
  
  
  CONCLUSIONS
  LAAO can be performed safely in a real world setting with good implant success rates and procedural outcomes. The long-term benefits of the procedure are reassuring in terms of both ischemic events and avoidance of severe bleeding associated with anticoagulation in this patient group. © 2016 Wiley Periodicals, Inc.
authors.affiliation: Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom.
authors.forename: Timothy R
authors.initials: TR
authors.lastname: Betts
authors.affiliation: Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom.
authors.forename: Milena
authors.initials: M
authors.lastname: Leo
authors.affiliation: Royal Brompton & Harefield Hospital NHS Foundation Trust, London, United Kingdom.
authors.forename: Sandeep
authors.initials: S
authors.lastname: Panikker
authors.affiliation: Imperial College Healthcare NHS Trust, London, United Kingdom.
authors.forename: Prapa
authors.initials: P
authors.lastname: Kanagaratnam
authors.affiliation: Imperial College Healthcare NHS Trust, London, United Kingdom.
authors.forename: Michael
authors.initials: M
authors.lastname: Koa-Wing
authors.affiliation: Imperial College Healthcare NHS Trust, London, United Kingdom.
authors.forename: David Wyn
authors.initials: DW
authors.lastname: Davies
authors.affiliation: Brighton and Sussex University Hospitals NHS Trust, Brighton, United Kingdom.
authors.forename: David
authors.initials: D
authors.lastname: Hildick-Smith
authors.affiliation: Brighton and Sussex University Hospitals NHS Trust, Brighton, United Kingdom.
authors.forename: Dylan G
authors.initials: DG
authors.lastname: Wynne
authors.affiliation: Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom.
authors.forename: Oliver
authors.initials: O
authors.lastname: Ormerod
authors.affiliation: University College London Hospitals NHS Foundation Trust, London, United Kingdom.
authors.forename: Oliver R
authors.initials: OR
authors.lastname: Segal
authors.affiliation: University College London Hospitals NHS Foundation Trust, London, United Kingdom.
authors.forename: Anthony W
authors.initials: AW
authors.lastname: Chow
authors.affiliation: Liverpool Heart and Chest Hospital NHS Foundation Trust, Liverpool, United Kingdom.
authors.forename: Derick
authors.initials: D
authors.lastname: Todd
authors.affiliation: Liverpool Heart and Chest Hospital NHS Foundation Trust, Liverpool, United Kingdom.
authors.forename: Sandra
authors.initials: S
authors.lastname: Cabrera Gomez
authors.affiliation: University Hospital of South Manchester NHS Foundation Trust, Manchester, United Kingdom.
authors.forename: Graeme J
authors.initials: GJ
authors.lastname: Kirkwood
authors.affiliation: University Hospital of South Manchester NHS Foundation Trust, Manchester, United Kingdom.
authors.forename: David
authors.initials: D
authors.lastname: Fox
authors.affiliation: Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom.
authors.forename: Chris
authors.initials: C
authors.lastname: Pepper
authors.affiliation: Royal Brompton & Harefield Hospital NHS Foundation Trust, London, United Kingdom.
authors.forename: John
authors.initials: J
authors.lastname: Foran
authors.affiliation: Royal Brompton & Harefield Hospital NHS Foundation Trust, London, United Kingdom.
authors.forename: Tom
authors.initials: T
authors.lastname: Wong
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D020517:Atrial Appendage / Q000000981:diagnostic imaging / Q000503:physiopathology; D001281:Atrial Fibrillation / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D006328:Cardiac Catheterization / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D020766:Intracranial Embolism / Q000209:etiology / Q000517:prevention & control*; D008297:Male; D008875:Middle Aged; D012042:Registries; D012189:Retrospective Studies; D012307:Risk Factors; D020521:Stroke / Q000209:etiology / Q000517:prevention & control*; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States
keywords: atrial fibrillation; left atrial appendage occlusion; thromboembolism