Amplatzer left atrial appendage occlusion: Single center 10‐year experience

Abstract

Objectives To report a 10‐year single center experience with Amplatzer devices for left atrial appendage (LAA) occlusion. Background Intermediate‐term outcome data following LAA occlusion are scarce. Methods Short‐ and intermediate‐term outcomes of patients who underwent LAA occlusion were assessed. All procedures were performed under local aesthesia without transesophageal echocardiography. Patients were discharged on acetylsalicylic acid and clopidogrel for 1–6 months. Results LAA occlusion was attempted in 152 patients (105 males, age 72 ± 10 years, CHA₂DS₂‐Vasc‐score 3.4 ± 1.7, HAS‐BLED‐score 2.4 ± 1.2). Nondedicated devices were used in 32 patients (21%, ND group) and dedicated Amplatzer Cardiac Plugs were used in 120 patients (79%, ACP group). A patent foramen ovale or atrial septal defect was used for left atrial access and closed at the end of LAA occlusion in 40 patients. The short‐term safety endpoints (procedural complications, bleeds) occurred in 15 (9.8%) and the efficacy endpoints (death, stroke, systemic embolization) in 0 patients. Device embolization occurred more frequently in the ND as compared to the ACP group (5 patients or 12% vs. 2 patients or 2%). Mean intermediate‐term follow up of the study population was 32 months (range 1–120). Late deaths occurred in 15 patients (5 cardiovascular, 7 noncardiac, 3 unexplained). Neurologic events occurred in 2, peripheral embolism in 1, and major bleeding in 4 patients. The composite efficacy and safety endpoint occurred in 7% and 12% of patients. Conclusion LAA closure may be a good alternative to oral anticoagulation. This hypothesis needs to be tested in a randomized clinical trial to ensure that all potential biases of this observational study are accounted for.