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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 closure followed by single antiplatelet therapy: Short- and mid-term outcomes
Zakaria Jalal1, Marie-Lou Dinet1, Nicolas Combes2
1Department of paediatric and adult congenital cardiology, university hospital of Bordeaux, avenue Magellan, 33600 Pessac, France.
Insights
Left atrial appendage closure (LAAC) with the AMPLATZER™ Cardiac Plug (ACP) device, followed by single antiplatelet therapy, offers a safe and effective stroke prevention strategy. This approach shows promising results for patients with atrial fibrillation who cannot take oral anticoagulants.
Area of Science:
- Cardiology
- Interventional Cardiology
- Medical Devices
Background:
- Optimal antithrombotic strategies post-left atrial appendage closure (LAAC) remain debated.
- Various antithrombotic protocols exist, necessitating further research into effective post-procedural management.
Purpose of the Study:
- To evaluate the efficacy and safety of LAAC using the AMPLATZER™ Cardiac Plug (ACP) device.
- To assess the outcomes of a single antiplatelet therapy regimen following LAAC.
Main Methods:
- A cohort of 76 patients with non-valvular atrial fibrillation and contraindications for oral anticoagulants underwent LAAC with an ACP device.
- Follow-up included clinical assessments and cardiac CT scans at 3 months to evaluate device performance and complications.
- Patients received single antiplatelet therapy for at least 12 months post-procedure.
Main Results:
- Successful LAAC was achieved in all patients, with low rates of major periprocedural complications.
- Device thrombosis occurred in 6.8% of patients, all asymptomatic.
- After a mean follow-up of 13 months, observed rates of death (2.6%), stroke (4.0%), and major bleeding (1.3%) were lower than predicted by risk scores.
Conclusions:
- Left atrial appendage closure (LAAC) with the ACP device, combined with single antiplatelet therapy, presents a viable alternative for stroke prevention.
- This strategy demonstrates favorable safety and efficacy profiles in high-risk patients.
Background:
After left atrial appendage closure (LAAC), various antithrombotic protocols have been suggested, but the optimal post-procedural antithrombotic strategy is still under debate.
Aims:
To investigate the efficacy and safety of LAAC with an AMPLATZER™ Cardiac Plug (ACP) device (St. Jude Medical, Minneapolis, MN, USA) followed by single antiplatelet therapy.
Methods:
Consecutive patients with non-valvular atrial fibrillation and a contraindication for oral anticoagulants who underwent LAAC with an ACP device between 2012 and 2014 in two French centres were included. Follow-up included clinical evaluation at 1, 3, 6 and 12 months, and yearly thereafter, and a cardiac computed tomography scan at 3 months to assess device position, device-related thrombus and residual leak. Single antiplatelet therapy was prescribed after the procedure for at least 12 months.
Results:
A total of 76 patients underwent successful LAAC (mean age: 73 years; 59% men; mean CHA2DS2-VASc score 4.4±1.3; mean HAS-BLED score 3.4±0.9). Three major complications occurred during the periprocedural period (one cardiac tamponade and two access site haematomas). Device thrombosis was observed at 3 months in five (6.8%) patients who remained asymptomatic. After a mean follow-up of 13 months, the rates of death, stroke and major bleeding were 2.6%, 4.0% and 1.3%, respectively. Embolic and bleeding events were less frequent than expected from CHA2DS2-VASc (4.0% vs 9.9%; P<0.001) and HAS-BLED (1.3% vs 4.3%; P<0.001) risk scores.
Conclusions:
LAAC using an ACP device followed by single antiplatelet therapy could be a reasonable alternative for stroke prevention.
