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Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation
Published on: February 26, 2013
Percutaneous left atrial appendage occlusion - treatment outcomes and 6 months of follow-up - a single-center
Michał Karczewski1, Sebastian Woźniak1, Radomir Skowronek1
1Department of Cardiac Surgery, Regional Specialist Hospital, Grudziądz, Poland.
Insights
Percutaneous left atrial appendage occlusion (PLAAO) is effective for non-valvular atrial fibrillation patients unable to take anticoagulants. The procedure showed no thrombi or major complications at 6-month follow-up.
Area of Science:
- Cardiology
- Interventional Cardiology
- Medical Devices
Background:
- Non-valvular atrial fibrillation (NVAF) increases stroke risk.
- Oral anticoagulation is contraindicated in some NVAF patients.
- Left atrial appendage occlusion offers an alternative stroke prevention strategy.
Purpose of the Study:
- To evaluate the efficacy and safety of percutaneous left atrial appendage occlusion (PLAAO).
- To assess 6-month outcomes in NVAF patients treated with PLAAO.
- To analyze complications and antiplatelet therapy response post-PLAAO.
Main Methods:
- PLAAO using the Amplatzer Amulet system in 34 NVAF patients.
- Assessment of thromboembolic and bleeding risk using CHA2DS2VASc and HAS-BLED scores.
- Post-procedure dual antiplatelet therapy (ASA/clopidogrel) with efficacy monitoring via Multiplate impedance aggregometry.
- Echocardiographic follow-up at 1 and 6 months.
Main Results:
- Successful occluder implantation with no leakage or peri-device thrombi observed.
- No strokes or major bleeding complications occurred.
- Dual antiplatelet therapy was effective for most, but 5/20 patients showed no response to clopidogrel. One cardiac tamponade and three local hematomas were reported.
Conclusions:
- PLAAO is an effective treatment for NVAF patients with contraindications to anticoagulation.
- The procedure demonstrates a favorable safety profile with appropriate monitoring.
- Long-term follow-up is warranted to confirm sustained efficacy and safety.
Aim:
To present the results of treatment and evaluate 6 months of follow-up in a group of patients with non-valvular atrial fibrillation, who underwent the procedure of percutaneous left atrial appendage occlusion (PLAAO).
Material And Methods:
Percutaneous left atrial appendage occlusion was performed in 34 patients with non-valvular atrial fibrillation and contraindications for oral anticoagulation therapy. The risk of thromboembolic and bleeding complications was determined based on the CHA2DS2VASc and HAS-BLED scales. The Amplatzer Amulet system from St. Jude Medical was used. On the first postoperative day, all patients were started on double antiplatelet therapy with 75 mg/day of acetylsalicylic acid (ASA) and 75 mg/day of clopidogrel (CLO). On the 30(th) postoperative day, the efficacy of the antiplatelet therapy was assessed with impedance aggregometry using a Multiplate analyzer (Roche). Echocardiographic examinations were performed intraoperatively and on the first postoperative day; subsequently, follow-up examinations were conducted 1 and 6 months after the implantation.
Results:
In all patients, proper occluder position was observed throughout the follow-up. No leakage or thrombi around the implants were found. No strokes or bleeding complications associated with the antiplatelet therapy were observed. Multiplate assessment of platelet activity was conducted in 20 out of 34 patients. The efficacy of ASA treatment was demonstrated in all patients; no response to clopidogrel treatment was observed in 5 out of 20 patients. One patient suffered from cardiac tamponade, which required the performance of full sternotomy. Local complications (hematomas of the inguinal region) were observed in 3 patients. One of the patients died for reasons unrelated to the procedure.
Conclusions:
Percutaneous left atrial appendage occlusion is an effective procedure in patients with non-valvular atrial fibrillation and contraindications for chronic anticoagulation therapy. Further observation is necessary to evaluate the longterm results.
