Author + information
- Received December 7, 2015
- Revision received March 15, 2016
- Accepted April 19, 2016
- Published online July 11, 2016.
- Konstantinos C. Koskinas, MD, MSca,
- Samera Shakir, MDa,
- Máté Fankhauser, MSa,
- Fabian Nietlispach, MDb,
- Adrian Attinger-Toller, MDb,
- Aris Moschovitis, MDa,
- Peter Wenaweser, MDa,
- Thomas Pilgrim, MDa,
- Stefan Stortecky, MDa,
- Fabien Praz, MDa,
- Lorenz Räber, MDa,
- Stephan Windecker, MDa,
- Bernhard Meier, MDa and
- Steffen Gloekler, MDa,∗ ()
- aCardiology, Cardiovascular Department, University Hospital of Bern, Bern, Switzerland
- bCardiology, University Hospital of Zurich, Zurich, Switzerland
- ↵∗Reprint requests and correspondence:
Dr. Steffen Gloekler, University Hospital of Bern, Department of Cardiology, Bern, Switzerland.
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.
Prof. Meier is a consultant to and has received grants to the institution from St. Jude Medical. Prof. Windecker has received grants to the institution from Abbott, Biotronik, Boston Scientific, Medtronic, Edwards Lifesciences, and St Jude Medical. Dr. Nietlispach is a consultant to St. Jude Medical, Edwards Lifesciences, Direct Flow Medical, and Medtronic. Dr. Gloekler has received a grant from the Swiss Heart Foundation. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose. Drs. Koskinas and Shakir contributed equally to this work.
- Received December 7, 2015.
- Revision received March 15, 2016.
- Accepted April 19, 2016.
- American College of Cardiology Foundation