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Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation
Published on: February 26, 2013
Does left atrial appendage closure with a cardiac plug system reduce the stroke risk in nonvalvular atrial
Paolo Danna1, Riccardo Proietti, Antonio Sagone
1Cardiology Department, Luigi Sacco Hospital, Milan, Italy.
Insights
Left atrial appendage (LAA) closure with the Amplatzer Cardiac Plug (ACP) device is a feasible option for reducing stroke risk in atrial fibrillation (AF) patients who cannot take anticoagulants.
Area of Science:
- Cardiology
- Interventional Cardiology
- Electrophysiology
Background:
- Atrial fibrillation (AF) is a common arrhythmia linked to increased stroke risk from cardiac embolism.
- The left atrial appendage (LAA) is a primary source of emboli in AF patients.
- Percutaneous LAA closure offers an alternative to anticoagulation for stroke risk reduction.
Purpose of the Study:
- To evaluate the safety and efficacy of LAA closure using the Amplatzer Cardiac Plug (ACP) device.
- To assess stroke prevention in AF patients with contraindications to warfarin therapy.
Main Methods:
- The study involved percutaneous LAA closure attempts using the ACP device in 37 patients.
- Patients selected had permanent or paroxysmal AF, high stroke risk, and contraindications to warfarin.
- A 1-year follow-up period was used to monitor safety and efficacy.
Main Results:
- Successful LAA closure was achieved in 34 out of 37 patients (91.9%).
- One ischemic stroke occurred during follow-up (2.94% stroke rate), representing a significant reduction compared to expected rates.
- Four patients experienced serious complications, including cardiac tamponade and device embolization. No major bleeding events were reported.
Conclusions:
- LAA closure with the ACP device is a feasible procedure for selected AF patients.
- The procedure can be performed by experienced operators to reduce stroke risk in patients unsuitable for oral anticoagulants.
Background:
Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia and it is associated with an increased stroke risk, due mainly to cardiac embolism from the left atrial appendage (LAA). Percutaneous LAA closure is a method to reduce stroke risk in AF without using anticoagulant agents. In this study we report data from an Italian experience with the LAA occluder Amplatzer Cardiac Plug (ACP) device (Aga Medical Corporation, Plymouth, MN, USA).
Methods:
The study was designed to evaluate the safety of LAA closure using ACP and the efficacy of the procedure in preventing strokes during a 1-year follow-up. Patients with permanent or paroxysmal AF, high stroke risk, and contraindication to warfarin therapy were selected for the procedure.
Results:
The LAA closure was attempted in 37 patients and succeeded in 34 cases (91.9%). Four patients experienced serious complications (one cardiac tamponade requiring pericardiocentesis, two device embolizations, one low-rate response AF requiring artificial pacing). During a 1-year follow-up, ischemic stroke occurred in one of 34 patients, resulting in a stroke rate of 2.94%; thus there was a stroke rate reduction of 50.2% and 26.5% compared to the expected stroke rate, according to CHADS2 and CHA2 DS2 VASc score. None of the patients who received ACP experienced major bleeding during the follow-up.
Conclusion:
LAA closure using ACP is a relatively feasible procedure which can be performed by highly experienced operators to reduce stroke rate in patients with AF, high stroke risk, and contraindication to oral anticoagulants.
