Abstract
BackgroundThe interventional left atrial appendage closure (LAAC) is a guideline-conform alternative to oral anticoagulation (OAC) in non-valvular atrial fibrillation patients with OAC ineligibility. It was aimed to directly compare two contemporary devices in a real-world patient population.MethodsLAAC was conducted in two centres between 2010 and 2014 as well as between 2014 and 2017, respectively, in a standard fashion based on the specific manufacturer’s recommendations. Baseline characteristics, procedural data and event rates during intra-hospital and 6 months follow-up were registered in a retrospective approach, and analysed in device-related groups.ResultsA total of 189 patients presented for LAAC device implantation. Baseline characteristics were mostly evenly distributed. In 148 patients, a Watchman™ device (Boston Scientific, Natick, MA, USA) was successfully implanted, an Amplatzer™ Amulet™ (St. Jude Medical, St. Paul, MN, USA) in 34 patients (96.1 and 97.1%, respectively; p = 1.00). Major access site bleedings were more frequent in the Amplatzer™ Amulet™ group (8.9 versus 1.4%; p = 0.046). No intra-hospital thromboembolic event was present. During 6 months follow-up, peri-device leaks > 5 mm and thromboembolic events were uncommon (each p = n.s.).ConclusionsWhile procedural success was equally high with both contemporary devices, complications during follow-up were rare, and evenly distributed.
Highlights
The interventional left atrial appendage closure (LAAC) is a guideline-conform alternative to oral anticoagulation (OAC) in non-valvular atrial fibrillation patients with OAC ineligibility
While procedural success was high with both contemporary devices, complications during follow-up were rare, and evenly distributed
The interventional left atrial appendage closure (LAAC) was implemented as a prophylactic alternative in all these above-mentioned cases. It is recommended by the European guidelines on atrial fibrillation in all patients with contraindications to long-term OAC [3]. This locoregional technique rests on the observation that > 90% of all emboli related to non-valvular Atrial fibrillation (AF) originate from the Fastner et al BMC Cardiovascular Disorders (2018) 18:171 left atrial appendage (LAA) [9]
Summary
The interventional left atrial appendage closure (LAAC) is a guideline-conform alternative to oral anticoagulation (OAC) in non-valvular atrial fibrillation patients with OAC ineligibility. The interventional left atrial appendage closure (LAAC) was implemented as a prophylactic alternative in all these above-mentioned cases It is recommended by the European guidelines on atrial fibrillation (class IIb) in all patients with contraindications to long-term OAC [3]. This locoregional technique rests on the observation that > 90% of all emboli related to non-valvular AF originate from the Fastner et al BMC Cardiovascular Disorders (2018) 18:171 left atrial appendage (LAA) [9]. While the patients in the RCT were anticoagulated for at least 45 days after the procedure, dual antiplatelet agents were shown to be an effective, and safe antithrombotic alternative in all those patients with an absolute contraindication for OAC [12, 13]
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