Aims:A significant subset of patients with atrial fibrillation (AF) and high risk of stroke, have contraindications to treatment with oral anticoagulants. Device occlusion of the left atrial appendage (LAA) has been shown to be equivalent to antigoagulation in eligible patients. Our aim was to assess the long-term outcomes in a single center after LAA occlusion with the Amplatzer Cardiac Plug (ACP), a device comprising of a retaining lobe for deployment within the LAA and an occluding disc for covering the LAA ostium.
Methods:Treatment with ACP was offered to patients with relative or absolute contraindications to oral anticoagulation. A specific published technique with low intraprocedural complication rates was used for all procedures. Recommended post procedural therapy was aspirin for life and clopidogrel for 30 days. Clinical, TTE and TEE follow-up were recommended. Patients not compliant with follow-up were contacted by telephone.
Results: Successful LAA occlusion was performed in 64 patients (38 males, mean age 77.0±9.0 years). Mean follow-up until November 2013 was 2.52±2.33 years with a total of 161.5 patient years. Mean CHADS2 score was 4.0±1.1 with 33 previous strokes. Median device size was 24mm (range 18-30mm). Periprocedural complications included one pericardial effusion. During follow-up, 5 thrombi
were noted on the disk screw (1 following TIA). All thrombi resolved with LMWH.
In all of these the disks were below the PV ridge. Four deaths occurred, one of which was stroke related. Four CVA/TIAs occurred during follow-up compared with a CHADS2 expected event incidence of 13.7 representing a RRR of 71%.
Conclusions: In a high-risk group of AF patients, the ACP was used to safely and effectively
acutely occlude the LAA. Thrombus formation on the device disk appears to be limited to deeply positioned disks. A very low stroke rate was noted over the follow-up period in this high-risk population.
