Original title: Percutaneous Left Atrial Appendage Closure With the AMPLATZER Cardiac Plug Device in Patients With Nonvalvular Atrial Fibrillation and Contraindication to Anticoagulation Therapy Reference: Marina Urena, et al. J Am Coll Cardiol 2013:62:96-102.

Anticoagulation is a good therapeutic strategy in nonvascular atrial fibrillation (AF). However, it is contraindicated in approximately 10% of patients, due to the risk of bleeding, apart from the fact that half of patients abandon treatment at year 3. In this context, left atrium closure devices could be beneficial.

The study included 52 patients that received the AMPLATZER Cardiac Plug (St. Jude Medical, Mineapolis, Minnesota) for nonvascular AF, with ≥2% risk of stroke determined by a  ≥1 CHADS2 score or a  ≥2  CHA2DS2-VASc score and absolute contraindication to anticoagulants.

29 patients had had Stokes and 3 had had transient ischemic attacks (TIA). They had all received aspirin and clopidogrel before procedure, and had continued with double antiagregation therapy for, at least, 30 days. 

Procedure was successful in 51 patients, there was one device embolization after implant, which was recovered with no further complications and another one presented a transient ischemic attack. A post procedure transesophageal echocardiography showed the presence of mild intra and peridevice leak in 1 and 6 patients, respectively, that disappeared in all but one, at follow up.

At 20±5 months, a patient presented TIA, one presented stroke, one cardiac obstruction, one major bleeding related to coronary angioplasty and 3 died of non related causes. Five patients presented a mild peridevice leak at 6 months, which was associated to a low ejection fraction (p=0.01) but did not cause an embolism.

Conclusion:

In patients with nonvalvular auricular fibrillation with elevated risk of cardiac embolism and anticoagulation contraindication,  percutaneous left atrial appendage closure with AMPLATZER followed by a simple or double aggregation therapy is associated with a low rate of embolism and bleeding at 20 months. There was no residual severe leak or device thrombosis at 6 months. 

Commentary:

The percutaneous left atrial appendage closure with the AMPLATZER is a viable safe alternative for patients with contraindication to anticoagulation therapy. At 20 months follow up, no cardiac embolism events were observed after implantation. Mild leaks were not related to events.

Courtesy of Dr Carlos Fava.
Interventional Cardiology.
Favaloro Foundation, Buenos Aires, Argentina.

Dr. Carlos Fava para SOLACI.ORG