Percutaneous left atrial appendage closure followed by single antiplatelet therapy: Short- and mid-term outcomes

Abstract

Background: After left atrial appendage closure (LAAC), various antithrombotic protocols have been suggested, but the optimal post-procedural antithrombotic strategy is still under debate.

Aims: To investigate the efficacy and safety of LAAC with an AMPLATZER™ Cardiac Plug (ACP) device (St. Jude Medical, Minneapolis, MN, USA) followed by single antiplatelet therapy.

Methods: Consecutive patients with non-valvular atrial fibrillation and a contraindication for oral anticoagulants who underwent LAAC with an ACP device between 2012 and 2014 in two French centres were included. Follow-up included clinical evaluation at 1, 3, 6 and 12 months, and yearly thereafter, and a cardiac computed tomography scan at 3 months to assess device position, device-related thrombus and residual leak. Single antiplatelet therapy was prescribed after the procedure for at least 12 months.

Results: A total of 76 patients underwent successful LAAC (mean age: 73 years; 59% men; mean CHA2DS2-VASc score 4.4±1.3; mean HAS-BLED score 3.4±0.9). Three major complications occurred during the periprocedural period (one cardiac tamponade and two access site haematomas). Device thrombosis was observed at 3 months in five (6.8%) patients who remained asymptomatic. After a mean follow-up of 13 months, the rates of death, stroke and major bleeding were 2.6%, 4.0% and 1.3%, respectively. Embolic and bleeding events were less frequent than expected from CHA2DS2-VASc (4.0% vs 9.9%; P<0.001) and HAS-BLED (1.3% vs 4.3%; P<0.001) risk scores.

Conclusions: LAAC using an ACP device followed by single antiplatelet therapy could be a reasonable alternative for stroke prevention.

Keywords: Accident vasculaire cerebral; Atrial fibrillation; Auricule gauche; Fermeture percutanée; Fibrillation atriale; Left atrial appendage; Percutaneous closure; Stroke.

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