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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\u003EThis article discusses follow-up results of the Study of Left Atrial Appendage Closure in Patients With Atrial Fibrillation III [PLACE III; \u003Ca class=\u0022external-ref external-ref-type-clintrialgov\u0022 href=\u0022\/lookup\/external-ref?link_type=CLINTRIALGOV\u0026amp;access_num=NCT01680757\u0026amp;atom=%2Fspmdc%2F14%2F9%2F16.1.atom\u0022\u003ENCT01680757\u003C\/a\u003E] in patients who underwent left atrial appendage (LAA) ligation with the LARIAT Suture Delivery Device (SentreHEART, Redwood City, California). Dr. Lee believes that the low incidence of access complications and embolic events in this high-risk atrial fibrillation population suggests that LAA ligation may be a treatment option for the prevention of thromboembolic complications in patients with contraindications to oral anticoagulation therapy.\u003C\/p\u003E\n         \u003C\/div\u003E\u003Cul class=\u0022kwd-group\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003EArrhythmias\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003ECardiology Clinical Trials\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EThrombotic Disorders\u003C\/li\u003E\u003C\/ul\u003E\u003Cul class=\u0022kwd-group clinical-trial\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003ECardiology \u0026amp; Cardiovascular Medicine\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EArrhythmias\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003ECardiology Clinical Trials\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EThrombotic Disorders\u003C\/li\u003E\u003C\/ul\u003E\u003Cp id=\u0022p-2\u0022\u003ERandy Lee, MD, PhD, University of California, San Francisco, San Francisco, California, USA, reported follow-up results of the Study of Left Atrial Appendage Closure in Patients With Atrial Fibrillation III [PLACE III; \u003Ca class=\u0022external-ref external-ref-type-clintrialgov\u0022 href=\u0022\/lookup\/external-ref?link_type=CLINTRIALGOV\u0026amp;access_num=NCT01680757\u0026amp;atom=%2Fspmdc%2F14%2F9%2F16.1.atom\u0022\u003ENCT01680757\u003C\/a\u003E] in patients who underwent left atrial appendage (LAA) ligation with the LARIAT Suture Delivery Device (SentreHEART, Redwood City, California). Dr. Lee believes that the low incidence of access complications and embolic events in this high-risk atrial fibrillation population suggests that LAA ligation may be a treatment option for the prevention of thromboembolic complications in patients with contraindications to oral anticoagulation therapy.\u003C\/p\u003E\u003Cp id=\u0022p-3\u0022\u003EThe purpose of this multicenter observational study was to assess the procedural and 30-day periprocedural safety of LAA closure with the LARIAT device. Long-term clinical end points included first event of stroke (ischemic, hemorrhagic, or undefined) or systemic embolism and stroke, systemic embolism, or death of any cause.\u003C\/p\u003E\u003Cp id=\u0022p-4\u0022\u003EThe study cohort consisted of 143 consecutive patients with nonvalvular AF, \u226518 years of age, with CHADS\u003Csub\u003E2\u003C\/sub\u003E scores \u22651, and with life expectancies \u22651 year who were not candidates for oral anticoagulation therapy. Patients underwent LAA ligation with the LARIAT device between December 2009 and November 2012. LAA closure was verified by left atrial angiography and transesophageal echocardiography. Patients received aspirin, aspirin with clopidogrel, or no antiplatelet therapy after LAA ligation. No patients were treated with oral anticoagulation therapy following LAA ligation.\u003C\/p\u003E\u003Cp id=\u0022p-5\u0022\u003EThe average age of the cohort was 67 years, and the majority of patients were male. Clinical characteristics were as follows: 24% had heart failure, 95% hypertension, and 32% prior stroke or transient ischemic attack; the mean CHADS\u003Csub\u003E2\u003C\/sub\u003E score was 2.4\u00b11.2; the mean CHADS\u003Csub\u003E2\u003C\/sub\u003E-VASc score was 3.6\u00b11.8; the mean HAS-BLED score was 2.8\u00b11.2; and the mean follow-up duration was 2.2\u00b11.1 years. Successful closure was obtained in 99.3% of patients (n=138).\u003C\/p\u003E\u003Cp id=\u0022p-6\u0022\u003EClinical outcomes at follow-up included 4 strokes (2 embolic\/ischemic strokes) and 6 deaths (1 procedural). The incidence of stroke, embolism, or death was 3.3% per year. The mean CHADS\u003Csub\u003E2\u003C\/sub\u003E score of the cohort was 2.4; previous studies have suggested that a cohort with this CHADS\u003Csub\u003E2\u003C\/sub\u003E score would be expected to have an incidence of stroke or systemic embolism of approximately 6.2%; however, in the patients treated with LAA ligation in this study, the incidence of stroke or systemic embolism was 1.3% per year [Gage BF et al. \u003Cem\u003ECirculation\u003C\/em\u003E 2004; \u003Cem\u003EJAMA\u003C\/em\u003E 2001].\u003C\/p\u003E\u003Cp id=\u0022p-7\u0022\u003EProcedure-related adverse events included pericardial effusion (n=1), pulmonary embolus (n=1), periprocedural death (n=1), and cardiac perforation (n=2). Inflammation-related adverse events included pericarditis (most initially; n=8), late hemopericardium (n=1), later pericardial effusion (n=1), and left atrial thrombus (n=2).\u003C\/p\u003E\u003Cp id=\u0022p-8\u0022\u003EThese findings suggest the need for prospective, appropriately powered, randomized stroke studies in patients with atrial fibrillation with contraindications or intolerance to oral anticoagulation therapy to assess the efficacy of LAA ligation.\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\/9\/16.1.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?nzp6g1\u0022\u003E\u003C\/script\u003E\n\u003C\/body\u003E\u003C\/html\u003E"}