Immediate and One-year Results in 35 Consecutive Patients After Closure of Left Atrial Appendage With the Amplatzer Cardiac Plug

• Published in: Revista española de cardiología (English ed.) 2013-02, Vol.66 (2), p.90-97
• Main Authors: López-Mínguez, José R., Eldoayen-Gragera, Javier, González-Fernández, Reyes, Fernández-Vegas, Concepción, Fuentes-Cañamero, María E., Millán-Nuñez, Victoria, Nogales-Asensio, Juan M., Martínez-Naharro, Ana, Sánchez-Giralt, Sara, Doblado-Calatrava, Manuel, Merchán-Herrera, Antonio
• Format: Article
• Language: English
• Subjects: Aged; Amplatzer occluder; Atrial Appendage - surgery; Atrial fibrillation; Atrial Fibrillation - surgery; Cartografía electroanatómica no fluoroscópica; Dispositivo oclusor; Female; Fibrilación auricular; Follow-Up Studies; Humans; Left atrial appendage; Magnetic resonance imaging; Male; Non-fluoroscopic electroanatomic mapping; Orejuela izquierda; Resonancia magnética; Septal Occluder Device; Time Factors; Tomografía computarizada; X-ray computerized tomography
• ISSN: 1885-5857; 1885-5857
• DOI: 10.1016/j.rec.2012.04.017

Left atrial appendage closure can be an attractive option for patients with nonvalvular atrial fibrillation and a contraindication to oral anticoagulants, provided that satisfactory results can be achieved during implantation and follow-up. Thirty-five consecutive patients, not eligible for randomized trials with oral anticoagulants, had an Amplatzer occlusion device implanted under general anesthesia. After the first 5 patients, 3-dimensional imaging was incorporated. The results of the implantation and the follow-up were analyzed over a 1-year period. The mean age was 74.65 (7.61) years, with a CHADS2 score of 2.41 (1.53) and a CHA2DS2-VASc score of 3.17 (1.60). Implantation failed in 1 patient and 5 needed a change in the selected plug size. There were no cardiac complications during the implantation or hospital stay. There was 1 vascular complication (arteriovenous fistula). Transesophageal echocardiography monitoring was performed at 24h, 1, 3, 6, and 12 months and we found 5 thrombi which were resolved with heparin. In the follow-up period of 21.14 (10.09) months, 3 patients aged>80 years died, none of them due to heart problems, and one transient ischemic stroke without further consequences. Left atrial appendage closure by an experienced operator can be a treatment option with few complications and with efficient results at>1 year in reducing thromboembolic and hemorrhagic complications, even in very high-risk groups. El cierre del apéndice auricular izquierdo puede ser una opción terapéutica atractiva para pacientes con fibrilación auricular no valvular y contraindicación para tomar anticoagulantes orales, siempre que se obtengan buenos resultados durante la implantación y en el seguimiento. Se analizó a 35 pacientes consecutivos y no elegibles para los estudios aleatorizados con anticoagulantes orales a los que se implantó el dispositivo oclusor Amplatzer. Tras los primeros 5 casos, se incorporó una técnica de imagen 3D. Se analizaron los resultados de la implantación y de seguimiento durante 1 año. La media de edad era 74,65 ± 7,61 años, con un CHADS2 de 2,41 ± 1,53 y un CHA2DS2-VASc de 3,17 ± 1,60. No se pudo implantar el dispositivo en 1 caso y en 5 fue necesario cambiar la medida seleccionada. No hubo ninguna complicación cardiaca durante la implantación ni durante la estancia hospitalaria. Hubo una complicación vascular (fístula arteriovenosa). Se realizó seguimiento con ecocardiografía transesofágica a las 24 h y tras 1, 3, 6 y 12 meses; se