6533b7d5fe1ef96bd126482e
RESEARCH PRODUCT
Percutaneous closure of left atrial appendage to prevent embolic events in high-risk patients with chronic atrial fibrillation
Alfredo R. GalassiCorrado TamburinoValeria CammalleriMarco BarbantiMassimiliano MulèGian Paolo UssiaSarah MangiaficoAnna MarcheseMarilena ScarabelliSebastiano Immèsubject
Malemedicine.medical_specialtyCardiac CatheterizationPercutaneousTime FactorsThromboembolism.left atrial appendage occlusionmedicine.medical_treatmentEmbolismSettore MED/11 - Malattie dell'Apparato CardiovascolareTransesophagealLeft atrial appendage occlusionPericardial effusionRisk AssessmentLeft atrialInternal medicineAtrial FibrillationmedicineHumansRadiology Nuclear Medicine and imagingAtrial Appendageatrial fibrillation; left atrial appendage occlusion; thromboembolism; Aged; Atrial Fibrillation; Contraindications; Echocardiography Transesophageal; Embolism; Equipment Design; Feasibility Studies; Female; Humans; Male; Middle Aged; Platelet Aggregation Inhibitors; Risk Assessment; Stroke; Time Factors; Treatment Outcome; Anticoagulants; Atrial Appendage; Cardiac Catheterization; Chronic DiseaseStrokeAgedbusiness.industryContraindicationsAnticoagulantsAtrial fibrillationGeneral MedicineEquipment DesignthromboembolismMiddle Agedmedicine.diseaseSurgeryStrokeTreatment OutcomePericardiocentesisEchocardiographyChronic DiseaseCardiologyPatent foramen ovaleFeasibility StudiesFemaleCardiology and Cardiovascular MedicinebusinessEchocardiography TransesophagealPlatelet Aggregation Inhibitorsdescription
Background: Percutaneous closure of the left atrial appendage (LAA) is a novel alternative for the treatment of patients with atrial fibrillation (AF) and with a high risk of stroke who are not eligible for long-term anticoagulation therapy. The aim of this study was to asses the safety, feasibility, and long-term efficacy of this procedure. Methods: From July 2004 to June 2007, 20 patients (13 male, mean age 69 ± 8 years) with non–valvular AF (NV-AF) underwent LAA percutaneous closure using the PLAATO™ system, implanted through a transeptal access. All patients had contraindications to anticoagulant therapy and were at high risk for cardioembolic stroke (mean CHADS2 score 3 ± 1.2). A trans-thoracic echocardiogram was performed at 1, 3, and every 6 months after the procedure, whereas a trans-oesophageal echocardiogram (TOE) was scheduled at 6 months. After 24 months, a phone interview was obtained. Results: All procedures were successfully performed in 18 patients. In two patients, LAA closure was not feasible for the presence of a multilobed LAA. Two patients underwent percutaneous closure of patent foramen ovale in the same session. In one patient, the procedure was complicated by cardiac perforation with pericardial effusion, treated with pericardiocentesis. At a mean follow up of 40 ± 10 months, no embolic events occurred. One patient died, after 36 months, for gastric cancer. TOE examination showed the complete exclusion of the LAA in all patients. Conclusions: Percutaneous closure of LAA is safe and efficacious to prevent stroke in patients with NV-AF at high risk for cardioembolic events, with contraindications to anticoagulant therapy. © 2009 Wiley-Liss, Inc.
| year | journal | country | edition | language |
|---|---|---|---|---|
| 2009-05-28 |