Epicardial standalone left atrial appendage clipping for prevention of ischemic stroke in patients with atrial fibrillation contraindicated for oral anticaogulation.

INTRODUCTION The most appropriate treatment for stroke prevention in stand-alone atrial fibrillation patients with a high CHADS2VASC score contraindicated for oral anticoagulation (OAC) or novel OAC (NOAC) still needs to be defined. Percutaneous left atrial appendage closure devices are available, but because of their endocardial positioning need a period of antiplatelet therapy. This study aimed to evaluate safety and efficacy of epicardial left atrial appendage clipping in patients contraindicated for (N)OAC and APT therapy. METHODS AND RESULTS We describe a standalone totally thoracoscopic LAA clipping of forty-five consecutive patients with non-valvular atrial fibrillation (32 males, age 73.1±7.4 years, CHADVASC6.5±1.1, HASBLED 4.9±0.9) with absolute contraindications to (N)OAC. The patients were selected by a multidisciplinary Heart Team. Sixty percent had a previous ischemic stroke and 51% a history of hemorrhagic event and 22% both. All patients were implanted with a LAA epicardial clip, guided by preoperative computed tomography and intraoperative transesophageal echocardiography. The mean procedural duration was 52.3±12.6 minutes with post procedural extubation interval of 22.8±14.6min. No procedure-related complications occurred. Intraprocedural TEE showed complete LAA occlusion in all patients. At mean follow-up of 16.4±9.1 months (range 2-34), with all patients off (N)OAC or Antiplatelet therapy, no ischemic stroke or hemorrhagic complications occurred. CT or TEE at follow-up demonstrated a correct LAA occlusion in all with mean stumps of 3.3 ±2.8mm. CONCLUSION Thoracoscopic epicardial closure of the LAA with the AtriClip PRO2 device is a potentially safe and efficient treatment for stroke prevention in patients with NVAF contraindicated for anticoagulant or antiplatelet therapy. This article is protected by copyright. All rights reserved.