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Left atrial appendage closure with Amplatzer cardiac plug for stroke prevention in atrial fibrillation: Initial Asia-Pacific experience.
MedLine Citation:
PMID:  21542102     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
BACKGROUND: Left atrial appendage (LAA) is the main source of left atrial thrombus that causes stroke in patients with non-valvular atrial fibrillation (NVAF). This study reported the initial safety, feasibility and 1-year clinical outcomes following AMPLATZER cardiac plug (ACP) implantation in Asia-Pacific region. METHODS: Twenty NVAF patients (16 males, age 68±9 years) with high risk for developing cardioembolic stroke (CHADS(2) score: 2.3±1.3) and contraindications to warfarin received ACP implants from June 2009 to May 2010. Patients received general anesthesia (n=9) or controlled propofol sedation (n=11) and the procedures were guided by fluoroscopy and transesophageal echocardiography (TEE). Clinical follow-up was arranged at 1 month and then every 3-month after implantation, whereas, a TEE was scheduled at 1 month upon completion of dual anti-platelet therapy. RESULTS: The LAA was successfully occluded in 19/20 patients (95%) at 2 Asian centers. One procedure was abandoned because of catheter-related thrombus formation. Other complications included coronary artery air embolism (n=1) and TEE-attributed esophageal injury (n=1). The median procedural and fluoroscopic times were 79 (IQR: 59-100) and 18 (IQR 12-27) minutes respectively. The mean size of implant was 23.6±3.1 mm. The average hospital stay was 1.8±1.1 days. Follow-up TEE showed all the LAA orifices were sealed without device-related thrombus formation. No stroke or death occurred at a mean follow-up of 12.7±3.1 months. CONCLUSIONS: Our preliminary data suggested LAA closure with ACP is safe, feasible with encouraging 1-year clinical outcomes. Further large-scaled trials are needed to confirm the efficacy of this device. © 2011 Wiley-Liss, Inc.
Authors:
Yat-Yin Lam; Gabriel Wk Yip; Cheuk-Man Yu; Wilson Wm Chan; Boron Cw Cheng; Bryan P Yan; Richard Clugston; Gerald Yong; Tim Gattorna; Vincent Paul
Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2011-5-3
Journal Detail:
Title:  Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions     Volume:  -     ISSN:  1522-726X     ISO Abbreviation:  -     Publication Date:  2011 May 
Date Detail:
Created Date:  2011-5-4     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  100884139     Medline TA:  Catheter Cardiovasc Interv     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Copyright Information:
Copyright © 2011 Wiley-Liss, Inc.
Affiliation:
Division of Cardiology, SH Ho Cardiovascular and Stroke Centre, Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong SAR. ylam@cuhk.edu.hk.
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