title: Percutaneous left atrial appendage closure followed by single antiplatelet therapy: Short- and mid-term outcomes.
abstract: BACKGROUND
  After left atrial appendage closure (LAAC), various antithrombotic protocols have been suggested, but the optimal post-procedural antithrombotic strategy is still under debate.
  
  
  OBJECTIVE
  To investigate the efficacy and safety of LAAC with an AMPLATZER™ Cardiac Plug (ACP) device (St. Jude Medical, Minneapolis, MN, USA) followed by single antiplatelet therapy.
  
  
  METHODS
  Consecutive patients with non-valvular atrial fibrillation and a contraindication for oral anticoagulants who underwent LAAC with an ACP device between 2012 and 2014 in two French centres were included. Follow-up included clinical evaluation at 1, 3, 6 and 12 months, and yearly thereafter, and a cardiac computed tomography scan at 3 months to assess device position, device-related thrombus and residual leak. Single antiplatelet therapy was prescribed after the procedure for at least 12 months.
  
  
  RESULTS
  A total of 76 patients underwent successful LAAC (mean age: 73 years; 59% men; mean CHA2DS2-VASc score 4.4±1.3; mean HAS-BLED score 3.4±0.9). Three major complications occurred during the periprocedural period (one cardiac tamponade and two access site haematomas). Device thrombosis was observed at 3 months in five (6.8%) patients who remained asymptomatic. After a mean follow-up of 13 months, the rates of death, stroke and major bleeding were 2.6%, 4.0% and 1.3%, respectively. Embolic and bleeding events were less frequent than expected from CHA2DS2-VASc (4.0% vs 9.9%; P<0.001) and HAS-BLED (1.3% vs 4.3%; P<0.001) risk scores.
  
  
  CONCLUSIONS
  LAAC using an ACP device followed by single antiplatelet therapy could be a reasonable alternative for stroke prevention.
authors.affiliation: Department of paediatric and adult congenital cardiology, university hospital of Bordeaux, avenue Magellan, 33600 Pessac, France. Electronic address: jalalzakaria1@gmail.com.
authors.forename: Zakaria
authors.initials: Z
authors.lastname: Jalal
authors.affiliation: Department of paediatric and adult congenital cardiology, university hospital of Bordeaux, avenue Magellan, 33600 Pessac, France.
authors.forename: Marie-Lou
authors.initials: ML
authors.lastname: Dinet
authors.affiliation: Paediatric and congenital heart disease unit, Pasteur clinic, Toulouse, France.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Combes
authors.affiliation: Department of paediatric and adult congenital cardiology, university hospital of Bordeaux, avenue Magellan, 33600 Pessac, France.
authors.forename: Xavier
authors.initials: X
authors.lastname: Pillois
authors.affiliation: Department of neurology, university hospital of Bordeaux, Bordeaux, France.
authors.forename: Pauline
authors.initials: P
authors.lastname: Renou
authors.affiliation: Department of neurology, university hospital of Bordeaux, Bordeaux, France.
authors.forename: Igor
authors.initials: I
authors.lastname: Sibon
authors.affiliation: Department of paediatric and adult congenital cardiology, university hospital of Bordeaux, avenue Magellan, 33600 Pessac, France.
authors.forename: Xavier
authors.initials: X
authors.lastname: Iriart
authors.affiliation: Department of paediatric and adult congenital cardiology, university hospital of Bordeaux, avenue Magellan, 33600 Pessac, France; Inserm 1045, university of Bordeaux, Bordeaux, France.
authors.forename: Jean-Benoît
authors.initials: JB
authors.lastname: Thambo
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001241:Aspirin / Q000008:administration & dosage* / Q000009:adverse effects; D020517:Atrial Appendage / Q000000981:diagnostic imaging / Q000503:physiopathology*; D001281:Atrial Fibrillation / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D006328:Cardiac Catheterization / Q000009:adverse effects / Q000295:instrumentation; D000077144:Clopidogrel; D004334:Drug Administration Schedule; D005260:Female; D005602:France; D006470:Hemorrhage / Q000139:chemically induced; D006801:Humans; D008297:Male; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage* / Q000009:adverse effects; D011446:Prospective Studies; D012042:Registries; D020521:Stroke / Q000209:etiology / Q000517:prevention & control; D013927:Thrombosis / Q000209:etiology / Q000517:prevention & control; D013988:Ticlopidine / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives*; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
chemical_list: D010975:Platelet Aggregation Inhibitors; D000077144:Clopidogrel; D013988:Ticlopidine; D001241:Aspirin
keywords: Accident vasculaire cerebral; Atrial fibrillation; Auricule gauche; Fermeture percutanée; Fibrillation atriale; Left atrial appendage; Percutaneous closure; Stroke