open access

Vol 75, No 9 (2017)
Original articles
Published online: 2017-06-01
Submitted: 2016-12-30
Accepted: 2017-04-18
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Percutaneous left atrial appendage occlusion procedures in patients with heart failure

Magdalena Szymała, Witold Streb, Katarzyna Mitręga, Tomasz Podolecki, Grzegorz Mencel, Tomasz Kukulski, Zbigniew Kalarus
DOI: 10.5603/KP.a2017.0115
·
Kardiol Pol 2017;75(9):868-876.

open access

Vol 75, No 9 (2017)
Original articles
Published online: 2017-06-01
Submitted: 2016-12-30
Accepted: 2017-04-18

Abstract

Background: Atrial fibrillation (AF) is the most common supraventricular tachyarrhythmia. Percutaneous left atrial appendage occlusion (LAAO) may be considered for stroke prophylaxis in patients with nonvalvular AF (NVAF), especially in contraindications for oral anticoagulants (OAC) or high risk of bleeding. The data about implantation, safety, efficacy, and follow-up are limited. Moreover, there are no studies on patients with NVAF and heart failure with severe left ventricular systolic dysfunction (left ventricular ejection fraction [LVEF] ≤ 35%).

Aim: To assess the safety, efficacy, and mid-term outcomes of LAAO procedures with Amplatzer Cardiac Plug (ACP) and Amplatzer Amulet device in patients with NVAF and heart failure with LVEF ≤ 35% (group I) and to perform a comparative analysis of the patients who had LAAO with NVAF and LVEF > 35%.

Methods: The analysis included 80 patients (group I: 19, group II: 61) with NVAF. The patients were enrolled for the study if they had: CHA2DS2VASc ≥ 2 and high risk of bleeding assessed in HAS-BLED (≥ 3) or less points in HAS-BLED but coexisting contraindications for OAC, or thromboembolic complications while using OAC. Time of follow-up was six months.

Results: In the studied population, the median CHA2DS2VASc score was 4 and the average HAS-BLED score was 3.2. Device implantation was successful in all patients from group I and in 59/61 patients from group II. The periprocedural clinical ef­ficacy (no thromboembolic complications) was 100% in group I and 98.4% in group II. Serious periprocedural complications (cardiac tamponade: 2.5%, device embolisation: 1.25%, unexplained death: 1.25%) occurred only in patients from group II (p = NS). The mid-term clinical efficacy was 100% in group I and 98.3% in group II (p = NS). During follow-up, one transient ischaemic attack and three deaths not related to the procedure occurred.

Conclusions: Percutaneous LAAO is an effective and safe procedure in patients with NVAF and severe systolic heart failure. No significant periprocedural and mid-term differences, in terms of safety and efficacy, between the group with severe systolic heart failure (LVEF ≤ 35%) and the group without severe left ventricular systolic dysfunction (LVEF > 35%) were found.

Abstract

Background: Atrial fibrillation (AF) is the most common supraventricular tachyarrhythmia. Percutaneous left atrial appendage occlusion (LAAO) may be considered for stroke prophylaxis in patients with nonvalvular AF (NVAF), especially in contraindications for oral anticoagulants (OAC) or high risk of bleeding. The data about implantation, safety, efficacy, and follow-up are limited. Moreover, there are no studies on patients with NVAF and heart failure with severe left ventricular systolic dysfunction (left ventricular ejection fraction [LVEF] ≤ 35%).

Aim: To assess the safety, efficacy, and mid-term outcomes of LAAO procedures with Amplatzer Cardiac Plug (ACP) and Amplatzer Amulet device in patients with NVAF and heart failure with LVEF ≤ 35% (group I) and to perform a comparative analysis of the patients who had LAAO with NVAF and LVEF > 35%.

Methods: The analysis included 80 patients (group I: 19, group II: 61) with NVAF. The patients were enrolled for the study if they had: CHA2DS2VASc ≥ 2 and high risk of bleeding assessed in HAS-BLED (≥ 3) or less points in HAS-BLED but coexisting contraindications for OAC, or thromboembolic complications while using OAC. Time of follow-up was six months.

Results: In the studied population, the median CHA2DS2VASc score was 4 and the average HAS-BLED score was 3.2. Device implantation was successful in all patients from group I and in 59/61 patients from group II. The periprocedural clinical ef­ficacy (no thromboembolic complications) was 100% in group I and 98.4% in group II. Serious periprocedural complications (cardiac tamponade: 2.5%, device embolisation: 1.25%, unexplained death: 1.25%) occurred only in patients from group II (p = NS). The mid-term clinical efficacy was 100% in group I and 98.3% in group II (p = NS). During follow-up, one transient ischaemic attack and three deaths not related to the procedure occurred.

Conclusions: Percutaneous LAAO is an effective and safe procedure in patients with NVAF and severe systolic heart failure. No significant periprocedural and mid-term differences, in terms of safety and efficacy, between the group with severe systolic heart failure (LVEF ≤ 35%) and the group without severe left ventricular systolic dysfunction (LVEF > 35%) were found.

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Keywords

heart failure, atrial fibrillation, stroke, left atrial appendage occlusion

About this article
Title

Percutaneous left atrial appendage occlusion procedures in patients with heart failure

Journal

Kardiologia Polska (Polish Heart Journal)

Issue

Vol 75, No 9 (2017)

Pages

868-876

Published online

2017-06-01

DOI

10.5603/KP.a2017.0115

Bibliographic record

Kardiol Pol 2017;75(9):868-876.

Keywords

heart failure
atrial fibrillation
stroke
left atrial appendage occlusion

Authors

Magdalena Szymała
Witold Streb
Katarzyna Mitręga
Tomasz Podolecki
Grzegorz Mencel
Tomasz Kukulski
Zbigniew Kalarus

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