Left atrial appendage closure - new choice for no-option patients with atrial fibrillation.

AIM: Remodeling and impaired blood flow in left atrial appendage (LAA), which occurs in patients with atrial fibrillation (AF), may lead to thrombus formation and possible thromboembolic complications. Although there are several pharmacological antithrombotic possibilities, some patients with several co-morbidities and contraindications to such treatment cannot be offered any of them. Therefore LAA closure systems may be an attractive alternative. We present our early experience with two currently available different LAA transcatheter closure systems (Watchman and Amplatzer Cardiac Plug).

METHODS

Twenty three patients (mean age 69.1±6.8 years, 12 male) with non-rheumatic AF and high risk of thromboembolic complications (CHA2DS2-VASc score ≥2 (mean 4.5±1.5), who could not be treated with the long-term oral anticoagulation because of contraindications or significant side effects, were qualified to the LAA closure.

RESULTS

The Amplatzer Cardiac Plug (St Jude Medical, St Paul, MN, USA) was implanted in 7 patients and Watchman Occluder (Boston Scientific, Boston, MA, USA) in the other 15 patients. The implantation was not performed in one patient as the transoesophageal echocardiography during the procedure revealed a new thrombus in LAA. The procedural details and follow-up data are presented. Neither severe pericardial effusion nor device related thrombus were observed. In long term follow-up transient ischemic attack was noted only in one patient (diagnosed with thrombophilia). One patient died 14 months after the procedure due to non-cardiac reason.

CONCLUSION

The LAA occluder implantation seems to be a safe and reasonable alternative for oral anticoagulation and should be considered in patients with AF who have contraindications or complications of pharmacological treatment.