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type=\u0022text\/css\u0022 rel=\u0022stylesheet\u0022 href=\u0022\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/advagg_css\/css__ce2QY63WIanKyr8eSq7eavr1XQRRmFD6ZSmwpyJi8lM__zXwFqpqmxrZOXXcd_TpBQpjuELbmIP9wBR5UuTDWAO4__YJWWMMdfCJuAFm5cUEp88OsodhO3ZA-2lzRfoBsSlk4.css\u0022 media=\u0022all\u0022 \/\u003E\n\u003Clink rel=\u0027stylesheet\u0027 type=\u0027text\/css\u0027 href=\u0027\/sites\/all\/modules\/contrib\/panels\/plugins\/layouts\/onecol\/onecol.css\u0027 \/\u003E\u003C\/head\u003E\u003Cbody\u003E\u003Cdiv class=\u0022panels-ajax-tab-panel panels-ajax-tab-panel-sageoa-tab-art\u0022\u003E\u003Cdiv class=\u0022panel-display panel-1col clearfix\u0022 \u003E\n  \u003Cdiv class=\u0022panel-panel panel-col\u0022\u003E\n    \u003Cdiv\u003E\u003Cdiv class=\u0022panel-pane pane-highwire-markup\u0022 \u003E\n  \n      \n  \n  \u003Cdiv class=\u0022pane-content\u0022\u003E\n    \u003Cdiv class=\u0022highwire-markup\u0022\u003E\u003Cdiv xmlns=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022 id=\u0022content-block-markup\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cdiv class=\u0022article fulltext-view \u0022\u003E\u003Cspan class=\u0022highwire-journal-article-marker-start\u0022\u003E\u003C\/span\u003E\u003Cdiv class=\u0022section abstract\u0022 id=\u0022abstract-1\u0022\u003E\u003Ch2\u003ESummary\u003C\/h2\u003E\n            \u003Cp id=\u0022p-1\u0022\u003EThe Amplatzer cardiac plug (ACP) is a self-expanding device designed to close the orifice of the left atrial appendage to prevent clot formation. This article presents data from trials and registries of ACP implantation in patients with atrial fibrillation.\u003C\/p\u003E\n         \u003C\/div\u003E\u003Cul class=\u0022kwd-group\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003EInterventional Techniques \u0026amp; Devices\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003ECardiology Clinical Trials\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003ECardiology\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EArrhythmias\u003C\/li\u003E\u003C\/ul\u003E\u003Cul class=\u0022kwd-group clinical-trial\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003EInterventional Techniques \u0026amp; Devices\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003ECardiology Clinical Trials\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003ECardiology \u0026amp; Cardiovascular Medicine\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EArrhythmias\u003C\/li\u003E\u003C\/ul\u003E\u003Cp id=\u0022p-2\u0022\u003EThe Amplatzer cardiac plug (ACP) is a self-expanding device designed to close the orifice of the left atrial appendage (LAA) to prevent clot formation. Reda Ibrahim, MD, University of Montreal, Montreal, Quebec, Canada, presented data from trials and registries of ACP implantation in patients with atrial fibrillation (AF).\u003C\/p\u003E\u003Cp id=\u0022p-3\u0022\u003EA European retrospective, multicenter data analysis of 143 patients scheduled for transcatheter ACP implantation focused on periprocedural technical and safety issues [Park JW et al. \u003Cem\u003ECatheter Cardiovasc Interv\u003C\/em\u003E 2011]. ACP implantation was attempted in 137 of the patients and was successful in 132 patients (96.4%). Ten procedural safety events (7%) were reported: stroke (n=3; 2.1%), serious pericardial effusion (n=5; 3.5%), and device embolization (n=2; 1.4%).\u003C\/p\u003E\u003Cp id=\u0022p-4\u0022\u003EAn EU prospective observational study with 6-month follow-up enrolled 204 patients with a history of AF [Walsh K et al. EuroPCR 2012]. The ACP was successfully implanted in 197 of the patients (96.6%). The closure rate was 99.5% at implant and 98.9% at 6 months. Residual flow \u0026gt;3 mm was observed in 0.5% of patients at implant and 1.1% at 6 months. At 6 months, the stroke rate was 1.98%, a 65% reduction from the expected stroke rate (based on the CHADS\u003Csub\u003E2\u003C\/sub\u003E score) of 5.6%. Six safety events (2.9%) were reported: serious pericardial effusion (n=3; 1.5%) and device embolization (n=3; 1.5%).\u003C\/p\u003E\u003Cp id=\u0022p-5\u0022\u003EThe Canadian registry implanted 52 patients and had a 98.1% procedural success rate. Complications included one embolization, one pericardial effusion, and one in-hospital transient ischemic attack [Urena M et al. \u003Cem\u003EJ Am Coll Cardiol\u003C\/em\u003E 2013]. At a mean follow-up of 20\u00b15 months, there was a 65% reduction in the expected stroke rate from 8.6% to 1.1% (p\u0026lt;0.001). Thromboembolic events (3.4%) and major bleeding (3.4%) were significantly reduced from expected rates (p\u0026lt;0.001 for both).\u003C\/p\u003E\u003Cp id=\u0022p-6\u0022\u003EA prospective Italian registry reported that in 134 patients with nonvalvular AF at high risk of stroke and bleeding, ACP implantation was successful in 118 patients (88.1%), with major complications in 1.5% [Stolcova M et al. \u003Cem\u003EJ Am Coll Cardiol\u003C\/em\u003E 2013 (abstr TCT-97)]. At a median follow-up of 22.8 months, stroke was reduced by 82% (p\u0026lt;0.01) and bleeding by 35% from the expected rates.\u003C\/p\u003E\u003Cp id=\u0022p-7\u0022\u003EA multicenter study attempted ACP implantation in 1047 patients [Tzikas A et al. TCT 2013 (abstr)]. The device was successfully implanted in 1019 patients (97.3%).\u003C\/p\u003E\u003Cp id=\u0022p-8\u0022\u003EMajor periprocedural complications were death (n=8; 0.76%), pericardial tamponade (n=13; 1.24%), major bleeding (n=13; 1.24%), stroke (n=9; 0.86%), device embolization (n=1; 0.10%), and myocardial infarction (n=1; 0.10%). At 1349 patient-years, stroke was reduced 59% from the expected rate of 5.62% to 2.30%; bleeding was reduced 61% from the expected 5.34% to 2.08%.\u003C\/p\u003E\u003Cp id=\u0022p-9\u0022\u003EA single-center prospective trial of 80 patients with AF compared the Watchman (n=40) and ACP (n=40) devices [Chun KRJ et al. \u003Cem\u003EHeart Rhythm\u003C\/em\u003E 2013]. Watchman implantation was successful in 38 patients (95%) compared with successful ACP implantation in all 40 patients (100%). Procedural complications included delayed tamponade in 2.5% of patients in both groups and air embolism in 2.5% of both groups. At 6 weeks, thrombus occurred in 3 Watchman patients (7.9%) and 1 ACP patient (2.5%). The device was dislodged in 1 ACP patient (\u003Ca id=\u0022xref-table-wrap-1-1\u0022 class=\u0022xref-table\u0022 href=\u0022#T1\u0022\u003ETable 1\u003C\/a\u003E).\u003C\/p\u003E\u003Cdiv id=\u0022T1\u0022 class=\u0022table pos-float\u0022\u003E\u003Cdiv class=\u0022table-inline\u0022\u003E\u003Cdiv class=\u0022callout\u0022\u003E\u003Cspan\u003EView this table:\u003C\/span\u003E\u003Cul class=\u0022callout-links\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022\/\u0022 class=\u0022table-expand-inline\u0022 data-table-url=\u0022\/highwire\/markup\/14800\/expansion?postprocessors=highwire_figures%2Chighwire_math%2Chighwire_inline_linked_media%2Chighwire_embed\u0026amp;table-expand-inline=1\u0022 html=\u00221\u0022 fragment=\u0022#\u0022 external=\u00221\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView inline\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022\/highwire\/markup\/14800\/expansion?width=1000\u0026amp;height=500\u0026amp;iframe=true\u0026amp;postprocessors=highwire_figures%2Chighwire_math%2Chighwire_inline_linked_media\u0022 class=\u0022colorbox colorbox-load table-expand-popup\u0022 rel=\u0022gallery-fragment-tables\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView popup\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/14800\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cdiv class=\u0022table-caption\u0022\u003E\u003Cspan class=\u0022table-label\u0022\u003ETable 1.\u003C\/span\u003E \n            \u003Cp id=\u0022p-10\u0022 class=\u0022first-child\u0022\u003EAmplatzer Cardiac Plug Versus Watchman Results\u003C\/p\u003E\n         \u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cp id=\u0022p-13\u0022\u003EProf. Ibrahim concluded that the ACP can be implanted successfully in a large proportion of patients. Randomized trials comparing the ACP with other devices and with oral medical therapy are needed to determine if the devices are efficacious and can improve outcomes for patients with atrial fibrillation.\u003C\/p\u003E\u003Cul class=\u0022copyright-statement\u0022\u003E\u003Cli class=\u0022fn\u0022 id=\u0022copyright-statement-1\u0022\u003E\u00a9 2014 MD Conference Express\u00ae\u003C\/li\u003E\u003C\/ul\u003E\u003Cspan class=\u0022highwire-journal-article-marker-end\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Cspan id=\u0022related-urls\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Ca href=\u0022http:\/\/mdc.sagepub.com\/content\/14\/21\/10.abstract\u0022 class=\u0022hw-link hw-link-article-abstract\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView Summary\u003C\/a\u003E\u003C\/div\u003E  \u003C\/div\u003E\n\n  \n  \u003C\/div\u003E\n\u003C\/div\u003E\n  \u003C\/div\u003E\n\u003C\/div\u003E\n\u003C\/div\u003E\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_openurl.js?nzp05d\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_tables.js?nzp05d\u0022\u003E\u003C\/script\u003E\n\u003C\/body\u003E\u003C\/html\u003E"}