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Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation
Published on: February 26, 2013
Predictors of Early (1-Week) Outcomes Following Left Atrial Appendage Closure With Amplatzer Devices
Konstantinos C Koskinas1, Samera Shakir1, Máté Fankhauser1
1Cardiology, Cardiovascular Department, University Hospital of Bern, Bern, Switzerland.
Insights
Left atrial appendage closure (LAAC) with Amplatzer devices shows high success. Predictors of adverse events include device repositioning and low ejection fraction, not LAA morphology.
Area of Science:
- Cardiology
- Interventional Cardiology
- Medical Devices
Background:
- Percutaneous left atrial appendage closure (LAAC) is crucial for stroke prevention in atrial fibrillation patients.
- Predictors of procedural safety events with Amplatzer occluders and the role of left atrial appendage (LAA) anatomy are not well understood.
Purpose of the Study:
- To identify predictors of adverse 1-week outcomes after LAAC.
- To evaluate the impact of LAA morphology on outcomes following LAAC with Amplatzer devices.
Main Methods:
- A total of 500 patients with atrial fibrillation underwent LAAC using Amplatzer devices between 2009 and 2014.
- Major adverse events (MAEs) were defined as death, stroke, major bleeding, pericardial effusion, device embolization, vascular complications, or need for surgery within 7 days.
- LAA morphology was angiographically classified into cauliflower, cactus, windsock, and chicken wing types.
Main Results:
- Procedural success was high (97.8%), with MAEs occurring in 5.8% of patients.
- Independent predictors of MAEs included device repositioning (OR: 9.13) and left ventricular ejection fraction <30% (OR: 4.08).
- No significant association was found between LAA morphology and procedural success or MAEs.
Conclusions:
- LAAC with Amplatzer devices is a safe and effective procedure with high success rates.
- Patient and procedural factors, rather than LAA morphology, predict early adverse events.
- Substantial heterogeneity in LAA anatomy does not appear to impact procedural outcomes.
Objectives:
The aim of this study was to assess predictors of adverse 1-week outcomes and determine the effect of left atrial appendage (LAA) morphology following LAA closure (LAAC) with Amplatzer devices.
Background:
Percutaneous LAAC is a valuable treatment option for stroke prevention in patients with atrial fibrillation. Determinants of procedural safety events with Amplatzer occluders are not well established, and the possibly interrelating effect of LAA anatomy is unknown.
Methods:
Between 2009 and 2014, 500 consecutive patients with atrial fibrillation ineligible or at high risk for oral anticoagulation underwent LAAC using Amplatzer devices. Procedure- and device-related major adverse events (MAEs) were defined as the composite of death, stroke, major or life-threatening bleeding, serious pericardial effusion, device embolization, major access-site vascular complication, or need for cardiovascular surgery within 7 days following the intervention.
Results:
Patients (mean age 73.9 ± 10.1 years) were treated with Amplatzer Cardiac Plug (n = 408 [82%]) or Amulet (n = 92 [18%]) devices. Early procedural success was 97.8%, and MAEs occurred in 29 patients (5.8%). Independent predictors of MAEs included device repositioning (odds ratio: 9.13; 95% confidence interval: 2.85 to 33.54; p < 0.001) and left ventricular ejection fraction <30% (odds ratio: 4.08; 95% confidence interval: 1.49 to 11.20; p = 0.006), with no effect of device type or size. Angiographic LAA morphology, characterized as cauliflower (33%), cactus (32%), windsock (20%), or chicken wing (15%), was not associated with procedural success (p = 0.51) or the occurrence of MAEs (p = 0.78).
Conclusions:
In this nonrandomized study, procedural success of LAAC using Amplatzer devices was high. MAEs within 7 days were predicted by patient- and procedure-related factors. Although LAA morphology displayed substantial heterogeneity, outcomes were comparable across the spectrum of LAA anatomies.
