Predictors of Early (1-Week) Outcomes Following Left Atrial Appendage Closure With Amplatzer Devices.

Koskinas, Konstantinos; Shakir, Samera; Fankhauser, Máté; Nietlispach, Fabian; Attinger-Toller, Adrian; Moschovitis, Aris; Wenaweser, Peter Martin; Pilgrim, Thomas; Stortecky, Stefan; Praz, Fabien; Räber, Lorenz; Windecker, Stephan; Meier, Bernhard; Glökler, Steffen (2016). Predictors of Early (1-Week) Outcomes Following Left Atrial Appendage Closure With Amplatzer Devices. JACC. Cardiovascular Interventions, 9(13), pp. 1374-1383. Elsevier 10.1016/j.jcin.2016.04.019

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OBJECTIVES The aim of this study was to assess predictors of adverse 1-week outcomes and determine the effect of left atrial appendage (LAA) morphology following LAA closure (LAAC) with Amplatzer devices. BACKGROUND Percutaneous LAAC is a valuable treatment option for stroke prevention in patients with atrial fibrillation. Determinants of procedural safety events with Amplatzer occluders are not well established, and the possibly interrelating effect of LAA anatomy is unknown. METHODS Between 2009 and 2014, 500 consecutive patients with atrial fibrillation ineligible or at high risk for oral anticoagulation underwent LAAC using Amplatzer devices. Procedure- and device-related major adverse events (MAEs) were defined as the composite of death, stroke, major or life-threatening bleeding, serious pericardial effusion, device embolization, major access-site vascular complication, or need for cardiovascular surgery within 7 days following the intervention. RESULTS Patients (mean age 73.9 ± 10.1 years) were treated with Amplatzer Cardiac Plug (n = 408 [82%]) or Amulet (n = 92 [18%]) devices. Early procedural success was 97.8%, and MAEs occurred in 29 patients (5.8%). Independent predictors of MAEs included device repositioning (odds ratio: 9.13; 95% confidence interval: 2.85 to 33.54; p < 0.001) and left ventricular ejection fraction <30% (odds ratio: 4.08; 95% confidence interval: 1.49 to 11.20; p = 0.006), with no effect of device type or size. Angiographic LAA morphology, characterized as cauliflower (33%), cactus (32%), windsock (20%), or chicken wing (15%), was not associated with procedural success (p = 0.51) or the occurrence of MAEs (p = 0.78). CONCLUSIONS In this nonrandomized study, procedural success of LAAC using Amplatzer devices was high. MAEs within 7 days were predicted by patient- and procedure-related factors. Although LAA morphology displayed substantial heterogeneity, outcomes were comparable across the spectrum of LAA anatomies.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Cardiovascular Disorders (DHGE) > Clinic of Cardiology

UniBE Contributor:

Koskinas, Konstantinos; Shakir, Samera; Nietlispach, Fabian; Moschovitis, Aris; Wenaweser, Peter Martin; Pilgrim, Thomas; Stortecky, Stefan; Praz, Fabien; Räber, Lorenz; Windecker, Stephan; Meier, Bernhard and Glökler, Steffen

Subjects:

600 Technology > 610 Medicine & health

ISSN:

1876-7605

Publisher:

Elsevier

Language:

English

Submitter:

Judith Liniger

Date Deposited:

12 Dec 2016 11:23

Last Modified:

12 Dec 2016 11:23

Publisher DOI:

10.1016/j.jcin.2016.04.019

PubMed ID:

27388826

Uncontrolled Keywords:

atrial fibrillation; complications; left atrial appendage closure; safety

BORIS DOI:

10.7892/boris.89710

URI:

https://boris.unibe.ch/id/eprint/89710

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