UNLABELLED: Percutaneous occlusion of the left atrial appendage (LAA) is a modern alternative for the treatment of patients with atrial fibrillation (AF) and with a high risk of stroke who are not eligible for long-term anticoagulation therapy. Echocardiography plays a significant role in selecting patients, guiding the procedure, and in the post-procedural follow-up. OBJECTIVES AND METHODS: To test the role of transesophageal echocardiography (TEE) and intracardiac echocardiography (ICE) in facilitating and shortening the procedure. RESULTS: ICE represents a more convenient approach in patients who are not under generally anesthesia and helps to facilitate transseptal puncture. On the other hand, TEE, having the ability to rotate the image plane, helps to better determine the position of the occluder. CONCLUSIONS: Echocardiographic guidance of this procedure is essential. Which approach will be preferred will depend on the development of these two methods.

• MeSH
• Balloon Occlusion * instrumentation   MeSH
• Echocardiography, Doppler, Color * MeSH
• Echocardiography, Transesophageal * MeSH
• Atrial Fibrillation therapy   MeSH
• Fluoroscopy MeSH
• Contrast Media MeSH
• Middle Aged MeSH
• Humans MeSH
• Follow-Up Studies MeSH
• Intraoperative Period MeSH
• Postoperative Period MeSH
• Aged, 80 and over MeSH
• Aged MeSH
• Atrial Appendage diagnostic imaging   MeSH
• Treatment Outcome MeSH
• Check Tag
• Middle Aged MeSH
• Humans MeSH
• Male MeSH
• Aged, 80 and over MeSH
• Aged MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Names of Substances
• Contrast Media MeSH

OBJECTIVE: Left atrial appendage (LAA) plays a crucial role in the etiopathogenesis and the prevention of the stroke in patients with nonvalvular atrial fibrillation (AF). This paper presents our first experience with thoracoscopic LAA occlusion using an external clip. METHODS: We performed a total of 30 LAA occlusions with the AtriClip from left thoracoscopy approach during the period from July 2012 to July 2013. AtriClip was implanted during the bilateral thoracoscopic radiofrequency (RF) as part of left atrial ablation procedure. RESULTS: Among the 30 procedures, AtriClip was once periprocedurally partially positioned. In the remaining procedures, the implantation was successful without complications. Of the 30 patients, 29 underwent transesophageal echocardiography and computer tomography examination at 3 months after the procedure. Apart from the patient with the partial clip placement, a residual pouch of 18 mm was detected in another patient. In the remaining group (28/30 patients, 93%), the exclusion was complete. No migration or any other clip implantation-related complications occurred during the follow-up. None of the patients experienced an embolization event. CONCLUSIONS: Endoscopic AtriClip implantation appears to be a reproducible and safe method of LAA occlusion, with a minimal risk and a high efficiency. In our opinion, the AtriClip implantation is a reasonable part of thoracoscopic AF treatment and should be considered as an alternative tool for stroke risk reduction in patients with AF.

• MeSH
• Stroke prevention & control   MeSH
• Echocardiography, Transesophageal methods   MeSH
• Atrial Fibrillation surgery   MeSH
• Catheter Ablation methods   MeSH
• Middle Aged MeSH
• Humans MeSH
• Tomography, X-Ray Computed MeSH
• Postoperative Complications MeSH
• Prostheses and Implants * MeSH
• Aged MeSH
• Atrial Appendage surgery   MeSH
• Thoracoscopy methods   MeSH
• Thromboembolism physiopathology   prevention & control   MeSH
• Treatment Outcome MeSH
• Check Tag
• Middle Aged MeSH
• Humans MeSH
• Male MeSH
• Aged MeSH
• Female MeSH
• Publication type
• Journal Article MeSH