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Transcatheter left atrial appendage occlusion for stroke prevention in patients with atrial fibrillation: Results from the Belgian registry

par Kefer, Joelle;Aminian, Adel;Vermeersch, Paul;De Potter, Tom;Stammen, Francis;Benit, Edouard;Budts, Werner;Missault, Luc;Drieghe, Benny;Buysschaert, Ian;Cornelis, Kristoff;Herzet, Jean Manuel;Guédès, Antoine;Debbas, Nadia;Rivero, Maximo;Lempereur, Mathieu;Lochy, Stijn;Casado Arroyo, Ruben ;Laruelle, Christophe;Debruyne, Philippe;Ledent, Thierry
Référence EuroIntervention, 13, 13, page (1603-1611)
Publication Publié, 2018-01

Article révisé par les pairs

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Résumé :

Aims: This study aimed to assess the safety and efficacy at midterm follow-up of left atrial appendage occlusion (LAAO) using different devices, in real life in Belgium. Methods and results: Between June 2009 and November 2016, 457 consecutive patients (63% male, 75±12 yrs, CHA2DS2-VASc 4±0.6, HAS-BLED 3.5±0.7) undergoing LAAO were included. Technical success was 97.1%. There were 19 periprocedural major adverse events (4.1%) including three deaths (0.6%), nine tamponades (1.9%), four major bleedings (0.8%) and two device embolisations (0.4%). Among patients successfully implanted having a complete follow-up (672 patient-years, median follow-up 370 days), the actual annual stroke rate was 1.2%, lower than the expected stroke risk of 4% (70% reduction). The observed bleeding rate was 2%, while the calculated risk was 3.7% (46% reduction). Kaplan- Meier analysis showed a similar overall survival (93±2% and 87±3% versus 91±3% and 87±4%; p=0.35) and event-free survival (92±2% and 84±3% versus 88±3% and 80±5%; p=0.17) at one and two years, for the ACP/Amulet versus the WATCHMAN groups of patients, respectively. Conclusions: The data from the Belgian left atrial appendage occlusion registry suggest that the procedure is effective and relatively safe in a real-world setting, using either the WATCHMAN or the ACP/Amulet device.