Percutaneous occlusion of left atrial appendage with the Amplatzer Cardiac PlugTM in atrial fibrillation
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Updated: May 25, 2026
Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation
Published on: February 26, 2013
Márcio José Montenegro1, Edgard Freitas Quintella, Aníbal Damonte
1Instituto Estadual de Cardiologia Aloysio de Castro, Rio de Janeiro, Brasil. marciojmontenegro@hotmail.com
Insights
Left atrial appendage occlusion offers a promising alternative to anticoagulation for patients with atrial fibrillation at high risk of stroke. Initial studies show feasibility and no periprocedural complications, warranting further clinical trials.
Area of Science:
- Cardiology
- Interventional Cardiology
- Medical Devices
Background:
- Atrial fibrillation (AF) significantly increases stroke risk due to emboli, often originating from the left atrial appendage (LAA).
- Anticoagulation is effective but underutilized due to limitations and bleeding risks.
- LAA occlusion is explored as an alternative stroke prevention strategy in AF.
Purpose of the Study:
- To assess the feasibility of percutaneous LAA occlusion.
- To evaluate the safety and efficacy of LAA occlusion in high-risk AF patients unsuitable for anticoagulation.
Main Methods:
- Initial experience with the Amplatzer Cardiac Plug™ device in nonvalvular AF patients.
- Patients selected based on high thromboembolism risk and anticoagulation contraindications/intolerance.
- Procedures performed percutaneously under general anesthesia with transesophageal echocardiography guidance.
Main Results:
- Successful LAA occlusion achieved in all five patients.
- No periprocedural complications were observed.
- No clinical embolic events occurred during the nine-month follow-up period.
Conclusions:
- Percutaneous LAA occlusion is a feasible and safe option for select high-risk AF patients.
- The Amplatzer Cardiac Plug™ shows promise as an alternative to anticoagulation.
- Further controlled clinical trials are necessary to establish LAA occlusion as a standard treatment.
Background:
Atrial fibrillation is associated with embolic strokes that often result in death or disability. Effective in reducing these events, anticoagulation has several limitations and has been widely underutilized. Over 90% of thrombi identified in patients with atrial fibrillation without valvular disease originate in the left atrial appendage, whose occlusion is investigated as an alternative to anticoagulation.
Objective:
To determine the feasibility of percutaneous occlusion of the left atrial appendage in patients at high risk of embolic events and limitations to the use of anticoagulation.
Methods:
We report our initial experience with Amplatzer Cardiac Plug™ (St. Jude Medical Inc., Saint Paul, Estados Unidos) in patients with nonvalvular atrial fibrillation. We selected patients at high risk of thromboembolism, major bleeding, contraindications to the use or major instability in response to the anticoagulant. The procedures were performed percutaneously under general anesthesia and transesophageal echocardiography. The primary outcome was the presence of periprocedural complications and follow-up program included clinical and echocardiographic review within 30 days and by telephone contact after nine months.
Results:
In five selected patients it was possible to occlude the left atrial appendage without periprocedural complications. There were no clinical events in follow-up.
Conclusion:
Controlled clinical trials are needed before percutaneous closure of the left atrial appendage should be considered an alternative to anticoagulation in nonvalvular atrial fibrillation. But the device has shown to be promissory in patients at high risk of embolism and restrictions on the use of anticoagulants.
