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Published on: February 26, 2013
Left Atrial Appendage Closure with Amplatzer Cardiac Plug in Nonvalvular Atrial Fibrillation: Safety and Long-Term
Marcio José Montenegro da Costa1, Esmeralci Ferreira2, Edgard Freitas Quintella1
1Instituto Estadual de Cardiologia Aloysio de Castro (IECAC); - Rio de Janeiro, RJ - Brazil.
Insights
Left atrial appendage closure (LAAC) using the Amplatzer Cardiac Plug is a safe and effective procedure for preventing stroke in patients with atrial fibrillation (AF). This study shows high success rates and no major complications at 12-month follow-up.
Area of Science:
- Cardiology
- Interventional Cardiology
- Medical Devices
Background:
- Atrial fibrillation (AF) significantly increases the risk of thromboembolic events, particularly stroke.
- Patients with nonvalvular AF often present with high risk scores for both thromboembolic events and bleeding.
- Left atrial appendage closure (LAAC) is an emerging strategy to mitigate these risks.
Purpose of the Study:
- To evaluate the safety and efficacy of the Amplatzer Cardiac Plug for LAAC in patients with nonvalvular AF.
- To assess the procedural success and long-term outcomes of this intervention.
Main Methods:
- A cohort of 15 patients with nonvalvular AF underwent LAAC using the Amplatzer Cardiac Plug.
- Patients were selected based on high risk for thromboembolic events and bleeding.
- Procedural success, device positioning, and clinical outcomes were assessed.
Main Results:
- The Amplatzer Cardiac Plug was successfully implanted in all patients, with excellent initial device positioning.
- No periprocedural complications, including device migration, tamponade, vascular issues, or major bleeding, were observed.
- At 12-month follow-up, no thromboembolic events or device-related bleeding occurred, with no evidence of device migration or thrombus formation on echocardiography.
Conclusions:
- LAAC with the Amplatzer Cardiac Plug is a safe and effective procedure for stroke prevention in high-risk patients with nonvalvular AF.
- The intervention demonstrates a high procedural success rate and a favorable 12-month clinical outcome.
- This approach offers a promising alternative for patients unsuitable for long-term anticoagulation.
Background:
Atrial fibrillation (AF) is a cardiac arrhythmia with high risk for thromboembolic events, specially stroke.
Objective:
To assess the safety of left atrial appendage closure (LAAC) with the Amplatzer Cardiac Plug for the prevention of thromboembolic events in patients with nonvalvular AF.
Methods:
This study included 15 patients with nonvalvular AF referred for LAAC, 6 older than 75 years (mean age, 69.4 ± 9.3 years; 60% of the male sex).
Results:
The mean CHADS2 score was 3.4 ± 0.1, and mean CHA2DS2VASc , 4.8 ± 1.8, evidencing a high risk for thromboembolic events. All patients had a HAS-BLED score > 3 (mean, 4.5 ± 1.2) with a high risk for major bleeding within 1 year. The device was successfully implanted in all patients, with correct positioning in the first attempt in most of them (n = 11; 73.3%).
Conclusion:
There was no periprocedural complication, such as device migration, pericardial tamponade, vascular complications and major bleeding. All patients had an uneventful in-hospital course, being discharged in 2 days. The echocardiographic assessments at 6 and 12 months showed neither device migration, nor thrombus formation, nor peridevice leak. On clinical assessment at 12 months, no patient had thromboembolic events or bleeding related to the device or risk factors. In this small series, LAAC with Amplatzer Cardiac Plug proved to be safe, with high procedural success rate and favorable outcome at the 12-month follow-up. (Arq Bras Cardiol. 2017; [online].ahead print, PP.0-0).
