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Heart Rhythm. 2013 Dec;10(12):1792-9. doi: 10.1016/j.hrthm.2013.08.025. Epub 2013 Aug 22.

Left atrial appendage closure followed by 6 weeks of antithrombotic therapy: a prospective single-center experience.

Author information

1
Medizinische Klinik III, Cardioangiologisches Centrum Bethanien, Markus Krankenhaus, Frankfurt am Main, Germany. Electronic address: j.chun@ccb.de.

Abstract

BACKGROUND:

Currently, 2 different left atrial appendage (LAA) closure systems are available for stroke prevention in nonvalvular atrial fibrillation but comparative data are lacking.

OBJECTIVES:

To prospectively compare procedural data and patient outcome for 2 contemporary LAA closure systems and to investigate an alternative antithrombotic treatment regimen in high-risk patients.

METHODS:

Patients with nonvalvular atrial fibrillation, with high risk for stroke, and who either had contraindication or were not willing to accept oral anticoagulation were prospectively enrolled. Watchman (Boston Scientific, Natick, MA; group A) or Amplatzer Cardiac Plug (St Jude Medical, Minneapolis, MN; group B) devices were implanted. All patients received antithrombotic therapy for 6 weeks. After repeat transesophageal echocardiography, patients were switched to aspirin.

RESULTS:

Eighty patients were enrolled. There was no statistical difference in patient characteristics in groups A and B: CHA2DS2VASC score: 4.1 ± 1.5 versus 4.5 ± 1.8; HASBLED score: 3.1 ± 1.1 versus 3.1 ± 1.1, respectively. LAA closure was achieved in 78 of 80 patients (98%) (group A: 38 of 40 [95%] vs group B: 40 of 40 [100%]). There was no difference in procedure time (group A: 48 ± 16 minutes vs group B: 47 ± 15 minutes; P = .69) and fluoroscopy time (group A: 6.0 ± 4.7 minutes vs group B: 7.3 ± 4.4 minutes; P = .25). Major complications included 1 air embolism and delayed tamponade in each group. After 6 weeks, 1 device dislodgment and 4 device-related thrombi were detected. Ninety-four percent of the patients (73 of 77) were switched to aspirin after 6 weeks. During a median follow-up of 364 days (Q1-Q3: 283-539 days), no systemic embolism occurred, but 3 patients died (heart failure: n = 2; bleeding: n = 1).

CONCLUSIONS:

Implantation of both LAA closure devices can be performed with high success rates in high-risk patients. Postprocedural 6 weeks antithrombotic therapy followed by aspirin therapy needs to be confirmed in a larger study.

KEYWORDS:

ACP; AF; ASA; Amplatzer Cardiac Plug; Atrial fibrillation; DPI; LA; LAA; Left atrial appendage closure; NVAF; OAC; PROTECT-AF; Percutaneous Closure of the Left Atrial Appendage Versus Warfarin Therapy for Prevention of Stroke in Patients With Atrial Fibrillation; Stroke; TEE; TIA; VKA; aspirin; atrial fibrillation; dual platelet inhibition; left atrial appendage; left atrium/atrial; nonvalvular atrial fibrillation; oral anticoagulation; transesophageal echocardiography; transient ischemic attack; vitamin K antagonist

PMID:
23973952
DOI:
10.1016/j.hrthm.2013.08.025
[Indexed for MEDLINE]

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