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Observational Study
. 2014 Jan 14;82(2):135-8.
doi: 10.1212/WNL.0000000000000022. Epub 2013 Dec 6.

Left atrial appendage occlusion in atrial fibrillation after intracranial hemorrhage

Solveig Horstmann  1 , Christian Zugck, Ulrike Krumsdorf, Timolaos Rizos, Geraldine Rauch, Nicolas Geis, Stefan Hardt, Roland Veltkamp
Affiliations
Observational Study

Left atrial appendage occlusion in atrial fibrillation after intracranial hemorrhage

Solveig Horstmann et al. Neurology. .

Abstract

Objective: To evaluate the safety and feasibility of percutaneous left atrial appendage occlusion (LAAO) in patients with atrial fibrillation (AF) and previous intracranial hemorrhage (ICH).

Methods: In an explorative, prospective, single-center, observational study, LAAO was performed in patients with previous ICH and AF using the Amplatzer Cardiac Plug device. Risks of ischemic strokes and hemorrhagic complications were estimated using the CHA2DS2Vasc score and the HAS-BLED score. Before and 1, 6, 12, and 24 months after the procedure, clinical status and complications were recorded. Major complications were predefined as periprocedural stroke, death, pericardial effusion, and device embolism.

Results: LAAO was performed in 20 patients. Based on CHA2DS2Vasc score (mean 4.5 ± 1.4) and HAS-BLED score (mean 4.7 ± 1.0), annual risks of stroke and hemorrhagic complications were 4.0%-6.7% and 8.7%-12.5%, respectively. No patient had a procedure-related complication. Minor postprocedural complications were observed in 4/20 patients (2 inguinal hematoma, 1 self-limiting asystole, and 1 thrombus formation on device). No ischemic or hemorrhagic stroke occurred during a mean follow-up of 13.6 ± 8.2 months.

Conclusions: In this first study of LAAO in patients with previous ICH, LAAO appears feasible and safe. A larger, controlled trial is needed to assess the efficacy and safety of the procedure compared to other preventive measures.

Classification of evidence: This study provides Class III evidence that in patients with a history of previous ICH and AF, percutaneous LAAO is safe and feasible.

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Figures

Figure
Figure. Flow diagram of study population
AF = atrial fibrillation; ICH = intracranial hemorrhage; LAAO = left atrial appendage occlusion; mRS = modified Rankin Scale; OAC = oral anticoagulation.
See this image and copyright information in PMC

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