Percutaneous closure of the left atrial appendage for thromboembolic prevention in atrial fibrillation | Revista Portuguesa de Cardiologia (English edition)

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LA: left atrium; LAA: left atrial appendage. Adapted from<a class="elsevierStyleCrossRef" href="#bib0135">27</a>." ] ] ] "textoCompleto" => "IntroductionAtrial fibrillation (AF) is a common arrhythmia with high morbidity and mortality due to its thromboembolic potential. Warfarin has been the first-line therapy for thromboembolic prevention, but it has various contraindications and limitations. Thrombi in AF form mainly in the left atrial appendage (LAA), and so closure of the LAA is considered an alternative to warfarin therapy.Prevalence of atrial fibrillationAF is the most common cardiac arrhythmia in clinical practice. Its prevalence in Portugal is 2.5% in those aged 40 or over according to the FAMA study.<a class="elsevierStyleCrossRef" href="#bib0005">1</a> The figure in the general population is 1–2%, rising with age; prevalence has increased significantly over time and is predicted to double in the next 50 years.<a class="elsevierStyleCrossRef" href="#bib0010">2</a>The importance of thromboembolism in atrial fibrillationThe risk of stroke is five times higher in those with AF than in those in sinus rhythm.<a class="elsevierStyleCrossRefs" href="#bib0010">2,3</a> The large size of the thrombi that cause these strokes means that their consequences tend to be more severe than from other sources of cerebral thrombi.<a class="elsevierStyleCrossRefs" href="#bib0010">2,4–6</a>Chronic anticoagulation with warfarinOral anticoagulation with warfarin remains the first-line therapy to prevent thromboembolic events in AF. It is indicated in all patients with CHADS2 or CHA2DS2-VASC score ≥2, and should also be considered with a score of 1.<a class="elsevierStyleCrossRef" href="#bib0010">2</a> Its efficacy has been demonstrated in numerous randomized clinical trials, which have shown that with a target international normalized ratio (INR) of 2–3, relative risk for stroke is reduced by 60–73%.<a class="elsevierStyleCrossRefs" href="#bib0010">2,4–9</a> Its superiority over aspirin (reduction of 20%<a class="elsevierStyleCrossRefs" href="#bib0010">2,7</a>), combined aspirin and clopidogrel, and a single antiplatelet drug plus low-dose warfarin,<a class="elsevierStyleCrossRefs" href="#bib0010">2,10,11</a> is well established.However, warfarin is contraindicated in 14–44% of patients at risk of stroke.<a class="elsevierStyleCrossRef" href="#bib0060">12</a> Even among eligible patients, only 54% are anticoagulated, for a variety of reasons, the most important being bleeding risk; others include a narrow therapeutic window and the sensitivity of its pharmacokinetics to a range of foods and other drugs, which necessitate frequent laboratory testing and the patient's cooperation. The risk of trauma, access to INR monitoring, clinicians’ wariness, and patient preferences can also make warfarin therapy impractical.<a class="elsevierStyleCrossRef" href="#bib0020">4</a> Anticoagulation is thus often inadequate, and INR values are within the therapeutic window in only 50–68% of tests.<a class="elsevierStyleCrossRef" href="#bib0045">9</a>New oral anticoagulantsNew anticoagulants have been developed as alternatives to warfarin for thromboembolic prevention in AF. There are two main classes: direct thrombin inhibitors such as dabigatran, and factor Xa inhibitors such as rivaroxaban, apixaban, edoxaban and betrixaban. They all have advantages over warfarin including a wider therapeutic window, fewer interactions with foods, and no need for laboratory monitoring.<a class="elsevierStyleCrossRef" href="#bib0010">2</a> Only dabigatran (the RE-LY study<a class="elsevierStyleCrossRef" href="#bib0065">13</a>), rivaroxaban (ROCKET-AF<a class="elsevierStyleCrossRef" href="#bib0070">14</a>) and apixaban (ARISTOTLE<a class="elsevierStyleCrossRef" href="#bib0075">15</a>) have demonstrated non-inferiority to warfarin in thromboembolic prevention in AF, and only the first two have been approved by the US Food and Drug Administration (FDA) for this purpose.<a class="elsevierStyleCrossRef" href="#bib0080">16</a> The latest guidelines for the management of atrial fibrillation of the European Society of Cardiology consider dabigatran an alternative in patients at high embolic risk if warfarin is contraindicated or impractical.<a class="elsevierStyleCrossRef" href="#bib0010">2</a> The latest Canadian Cardiovascular Society guidelines also recommend the use of dabigatran rather than warfarin in AF patients with indication for oral anticoagulation.<a class="elsevierStyleCrossRef" href="#bib0085">17</a>However, these drugs are expensive for chronic therapy, carry a significant risk of bleeding, and do not have an established antidote, all which are obstacles to their use in many patients. Studies on these new anticoagulants have also shown significant rates of discontinuation of therapy, mainly due to intolerance or adverse effects, reaching 25.3% in patients taking apixaban (vs. 27.5% for those taking warfarin) in the ARISTOTLE trial,<a class="elsevierStyleCrossRef" href="#bib0075">15</a> but higher than seen for warfarin in the RE-LY<a class="elsevierStyleCrossRef" href="#bib0065">13</a> (21% for dabigatran vs. 17%) and ROCKET-AF<a class="elsevierStyleCrossRef" href="#bib0070">14</a> (23.7% for rivaroxaban vs. 22.2%) trials.The importance of the left atrial appendage in thromboembolismThe LAA is an embryonic remnant of the left atrium (LA) consisting of a long tubular body with walls as little as 1mm thick, usually multilobulated and trabeculated, that communicates with the LA through an oval orifice.<a class="elsevierStyleCrossRefs" href="#bib0090">18,19</a> It is generally thought to have a role in regulating body volume via physiological mechanisms that include the production of 30% of atrial natriuretic peptide, regulation of thirst, and modulation of the volume/pressure ratio and LA compliance, and hence cardiac output.<a class="elsevierStyleCrossRefs" href="#bib0100">20–22</a>The LAA is also the most common site of intracardiac thrombi in AF (98%), as demonstrated in autopsy studies, by transesophageal echocardiography (TEE) and by direct intraoperative inspection.<a class="elsevierStyleCrossRefs" href="#bib0055">11,12,18,19</a> It is more frequently the site of thrombi in non-valvular (90%) than valvular AF (57%),<a class="elsevierStyleCrossRefs" href="#bib0060">12,18,19</a> and in patients with previous ischemic stroke.<a class="elsevierStyleCrossRef" href="#bib0100">20</a>In the light of these facts, exclusion of the LAA from the circulation was seen as an alternative to pharmacological anticoagulation to prevent thromboembolism in AF. Different methods have been developed, some more invasive than others.<a class="elsevierStyleCrossRefs" href="#bib0060">12,13</a>Surgical exclusion of the LAAThe first attempt to surgically exclude the LAA, during mitral valve surgery, was described in the 1930s.<a class="elsevierStyleCrossRef" href="#bib0025">5</a> The LAAOS study, the first randomized trial of surgical LAA occlusion, in patients referred for coronary bypass surgery at risk for AF or ischemic stroke, concluded that surgical exclusion of the LAA was safe and did not increase operative time or perioperative bleeding.<a class="elsevierStyleCrossRef" href="#bib0115">23</a>Surgical exclusion began to be performed in various centers, but it was then discovered that exclusion was often incomplete, and success rates varied widely (10.3–60%<a class="elsevierStyleCrossRef" href="#bib0110">22</a>) due to differences in surgical techniques, surgical expertise, and criteria for success.Kanderian et al.<a class="elsevierStyleCrossRef" href="#bib0110">22</a> retrospectively analyzed TEEs performed after surgical LAA closure, which was not at that time a routine procedure, and found a higher failure rate than those seen in small series, in which the criteria for occlusion were less rigorous. The authors concluded that excision was the most effective technique and that incomplete closure increased the likelihood of blood pooling and thrombus formation; they recommended that anticoagulation should be continued until confirmation of complete occlusion by TEE.Open surgery for LAA closure via an epicardial approach has also been performed using the AtriCure system (AtriClip, Cincinnati, OH) in AF patients undergoing coronary bypass surgery or valve replacement; the three-month success rate was 100%.<a class="elsevierStyleCrossRef" href="#bib0065">13</a> A thoracoscopic epicardial approach was used for LAA occlusion in 15 patients for thromboembolic prevention, and in many other small series during AF ablation.<a class="elsevierStyleCrossRef" href="#bib0120">24</a> However, this approach was associated with additional complications including pneumothorax and need for conversion to open surgery due to bleeding, adherences, or other problems.<a class="elsevierStyleCrossRef" href="#bib0120">24</a>The invasive nature of surgical LAA occlusion means that it has only been performed during cardiac surgery for another reason. It is used as part of the MAZE procedure<a class="elsevierStyleCrossRefs" href="#bib0025">5,22</a> and is recommended in the ACC/AHA guidelines on valvular heart disease during mitral valve surgery.<a class="elsevierStyleCrossRef" href="#bib0125">25</a>Minimally invasive LAA exclusionThe invasive nature of surgical LAA exclusion has prompted the development of closure devices using minimally invasive methods, including techniques combining epicardial and endocardial approaches. One example is the LARIAT® system (SentreHEART, Palo Alto, CA), approved by the FDA, which combines epicardial delivery of a snare with a pre-tied suture via a small-caliber catheter and a balloon catheter introduced endocardially using a magnet-tipped guidewire to position the suture around the base of the LAA. The system was assessed in AF patients undergoing mitral valve surgery (n=2) or AF ablation (n=11), and its feasibility was demonstrated.<a class="elsevierStyleCrossRef" href="#bib0130">26</a>Percutaneous LAA closure techniques have also been developed that use an exclusively endocardial approach.Endocardial percutaneous LAA closurePercutaneous LAA closure using an endocardial approach is based on delivery of the device via a percutaneous catheter introduced through a femoral vein that reaches the LAA via septal puncture. Implantation is guided by fluoroscopy and/or TEE. An intravenous heparin bolus is administered to achieve partial activated thromboplastin time of ≥250 s.<a class="elsevierStyleCrossRefs" href="#bib0100">20,27,28</a>The PLAATO deviceThe first percutaneous LAA closure device was the PLAATO (Percutaneous Left Atrial Appendage Transcatheter Occlusion) system (ev3 Inc., Plymouth, MN).<a class="elsevierStyleCrossRef" href="#bib0135">27</a> It consisted of a self-expanding nitinol cage coated with a polytetrafluoroethylene membrane designed both to occlude LAA flow and to allow tissue incorporation into the device. There were also three rows of anchors to attach the device to the LAA orifice (<a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>).<a class="elsevierStyleCrossRef" href="#bib0135">27</a><elsevierMultimedia ident="fig0005"></elsevierMultimedia><a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a> lists data on the main clinical trials on the PLAATO device. The first clinical trial in Europe, by Sievert et al.,<a class="elsevierStyleCrossRef" href="#bib0135">27</a> included 15 patients with chronic non-rheumatic AF, high risk for thromboembolism on CHADS2 criteria or with spontaneous echo contrast in the LAA and contraindications to warfarin. Device implantation was successful in all patients, with no residual shunt, new thrombus formation on the device, device migration or thromboembolic phenomena at one-month follow-up. The only complication was one case of pericardial effusion resolved by pericardiocentesis.<a class="elsevierStyleCrossRef" href="#bib0135">27</a>This was followed by an international multicenter prospective trial by Ostermayer et al.,<a class="elsevierStyleCrossRef" href="#bib0140">28</a> which included results from five centers in Europe and North America and was the largest study on the PLAATO device. The study population consisted of patients with non-rheumatic AF of at least three months’ duration, contraindication to warfarin and high risk for thromboembolic events (history of myocardial infarction or significant coronary stenosis, CHADS2 criteria or moderate or dense spontaneous contrast or blood flow velocity ≤20cm/s within the LAA on echocardiography). It was the first study to use angiographic grading to evaluate LAA occlusion (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>), which was also assessed by transesophageal color Doppler echocardiography and graded on a five-point scale (<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>).<elsevierMultimedia ident="tbl0005"></elsevierMultimedia><elsevierMultimedia ident="tbl0010"></elsevierMultimedia>Occlusion was successful in 97.3% of cases (108/111). During a mean follow-up of 10 months, the stroke rate was 2.2%; these two events occurred 6–7 months after the implant procedure, and in both cases the device was in stable position with no significant leak or adhering thrombi. The authors calculate that this rate was one-third of that predicted on the basis of the patients’ mean CHADS2 score of 2.5 points (estimated annual stroke rate of 6.3%).Five patients among the first to undergo the technique experienced pericardial effusion, which was attributed to lack of experience with the technique. One required surgery and died from postoperative complications. There were no other significant complications and no instances of device dislocation or migration (<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>).<a class="elsevierStyleCrossRef" href="#bib0140">28</a><elsevierMultimedia ident="tbl0015"></elsevierMultimedia>The largest series of patients treated with the PLAATO device, reported by Park et al.,<a class="elsevierStyleCrossRef" href="#bib0145">29</a> was in a single German center. Percutaneous LAA closure was performed in 71 patients with rheumatic and non-rheumatic AF, most chronic but paroxysmal in eight cases, with contraindication to oral anticoagulation or history of stroke under anticoagulant therapy.Occlusion was successful in 97.3% of patients. In a mean follow-up of 24 months, one minor stroke was reported (1.4%), a lower rate than the 5% predicted on the basis of a mean CHADS2 score of 2.5. One device embolization occurred, occluding the left ventricular outflow tract, resulting in the patient's death, and there was one case of device instability requiring removal by open surgery.Ten deaths (7%) occurred during follow-up, but only one (described above) was procedure-related. There was one case of pericardial effusion, which resolved without pericardiocentesis (<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>).<a class="elsevierStyleCrossRef" href="#bib0145">29</a>A prospective non-randomized multicenter clinical trial in North America, that of Block et al.,<a class="elsevierStyleCrossRef" href="#bib0150">30</a> analyzed 64 patients with non-valvular FA (chronic or paroxysmal) not eligible for chronic warfarin therapy and with CHADS2 score of ≥2. The procedure was successful in 93.8% of patients; mean follow-up was 3.75 years, and up to five years in some cases. The stroke rate was 3.8%: five major (between 7 and 53 months after the procedure) and three minor (8–23 months). There was one transient ischemic attack (TIA). The total stroke/TIA rate of 3.8% was little more than half that predicted by the mean CHADS2 score of 2.6 (6.6%).There were two deaths, one from cerebral hemorrhage and the other from surgical complications unrelated to the device or the closure technique. The only procedure-related complication was a pericardial effusion requiring surgery (<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>).<a class="elsevierStyleCrossRef" href="#bib0150">30</a>Other smaller series have been published from different centers, all of them confirming the efficacy of the PLAATO device for preventing stroke in AF. However, the device was eventually withdrawn from the market by the manufacturer.Amplatzer devicesThe second device to be used for percutaneous LAA closure was the Amplatzer septal occluder (St. Jude Medical, Plymouth, MN), which was originally used to close atrial septal defects (ASD). It was tested in 16 patients in four centers in 2002 by Meier et al.,<a class="elsevierStyleCrossRef" href="#bib0155">31</a> who reported a single complication, embolization of an inappropriately sized device. The septal occluder was not used again for this purpose; instead, a device was developed specifically for LAA closure, the Amplatzer Cardiac Plug (ACP) (St. Jude Medical, Plymouth, MN),<a class="elsevierStyleCrossRef" href="#bib0160">32</a> with a self-expanding nitilol frame covered in a polyester patch, consisting of a lobe and a disc connected by a central waist. Hooks on the lobe fix the device, while the disc seals the LAA orifice (<a class="elsevierStyleCrossRef" href="#fig0010">Figure 2</a>). It is available in eight lobe sizes from 16 to 30 mm at 2-mm intervals.<a class="elsevierStyleCrossRef" href="#bib0160">32</a><elsevierMultimedia ident="fig0010"></elsevierMultimedia>As the ACP began to be widely used, and in the light of safety concerns, Park et al.<a class="elsevierStyleCrossRef" href="#bib0160">32</a> reviewed the experience of various centers to assess its safety profile, retrospectively analyzing implantations from its first use in December 2008 to November 2009, in a total of 143 AF patients in 10 European centers. Warfarin was suspended in all cases before ACP implantation, while dual antiplatelet therapy was maintained for 1–3 months, followed by single antiplatelet therapy indefinitely (<a class="elsevierStyleCrossRef" href="#tbl0020">Table 4</a>).<elsevierMultimedia ident="tbl0020"></elsevierMultimedia>The registry did not aim to assess indications for LAA closure or the effectiveness of the procedure, but to analyze the feasibility and safety of the ACP 24 hours after implantation. This was successful in 96% of patients; in the remainder implantation was unsuccessful due to device embolization (n=2) or unfavorable anatomy (n=3). The device needed replacing in 17% of cases.Serious complications were seen in 10 patients (7%): three with stroke due to air embolism or intracardiac thrombus; device embolization in two cases, both percutaneously recaptured, with no sequelae; and five with pericardial effusion requiring pericardiocentesis. Minor complications were insignificant pericardial effusions in four, transient myocardial ischemia due to air embolism in two, and loss of the implant in the venous system in one patient, recovered percutaneously (<a class="elsevierStyleCrossRef" href="#tbl0020">Table 4</a>).The authors concluded that the ACP could be successfully implanted in a slightly higher proportion of patients than in the PROTECT AF trial,<a class="elsevierStyleCrossRef" href="#bib0040">8</a> with a similar adverse event rate. They also stressed the importance of the learning curve in reducing procedure-related complications. The ability of the LAA to adapt to pressure was given as the main reason for incorrect device sizing, but the authors also pointed out that the ACP is a more flexible device and thus better able to adapt to the oval shape of the LAA orifice. One cause they identified for pericardial effusion was perforation of the LAA, due to its thin walls; as causes of periprocedural stroke, they reported air embolism and small LAA thrombi located in fully contracted lobes that were not visualized on TEE, and suggest these could be detected by multiple contrast injections. The periprocedural stroke rate was 2%.<a class="elsevierStyleCrossRef" href="#bib0160">32</a>This registry made no mention of formation of thrombi on the ACP, but reports subsequently appeared of thrombi adhering to the device. In one case, a patient with chronic AF, CHADS2 score of 2 and contraindication to oral anticoagulation, underwent successful percutaneous LAA exclusion and was prescribed clopidogrel for one month and aspirin indefinitely, but TEE at three-month follow-up revealed a thrombus adhering to the device, which was resolved by enoxaparin 60mg twice daily and aspirin, continued thereafter.<a class="elsevierStyleCrossRef" href="#bib0165">33</a> In another case, percutaneous LAA closure with the ACP was successfully performed in a patient with chronic AF, CHADS2 score of 6 and contraindication to oral anticoagulation due to chronic hematuria, who was prescribed clopidogrel and aspirin. Six-month follow-up TEE detected a thrombus on the device, treated by intravenous heparin, which took three weeks to have any effect in reducing the thrombus. Oral anticoagulation was accordingly started but had to be discontinued due to hematuria; no thromboembolic events were recorded.<a class="elsevierStyleCrossRef" href="#bib0170">34</a>In view of increasing concerns over this complication, in January 2011 the manufacturer (at that time AGA Medical), after investigating these cases, published a Field Safety Notice for all centers implanting the ACP, updating the instructions for use, stating that the most likely cause for thrombus formation on the device was excessively deep implantation, and emphasizing the importance of measuring the depth of the LAA and width of the orifice at the implantation site. It also claims that adequacy of the anticoagulation and/or antiplatelet regimen can also be considered a potential contributor in thrombus formation, recommending aspirin for six months post-implant, leaving the decision to continue this regimen after six months at the discretion of the physician, and recommending clopidogrel or an alternate antiplatelet, with prescription following routine standard of care.<a class="elsevierStyleCrossRef" href="#bib0175">35</a>In April 2011 Plicht et al. published a series assessing thrombus formation on the ACP in 31 patients, all of whom were medicated after implantation in accordance with the manufacturer's instructions. They underwent TEE before discharge and at three and six months; device thrombus was detected in three patients on the pre-discharge TEE and in three more at three months. In three of these patients the thrombi resolved after intravenous heparin administration for one week and oral anticoagulation was reinitiated for another three months in the other three, and one patient still had thrombus at the time of publication. The authors found no significant difference in the implantation site between those with and those without thrombi, and considered that thrombus formation in their series did not appear to be related to deep device implantation.<a class="elsevierStyleCrossRef" href="#bib0180">36</a>The experience of a single Swiss center was published in May 2012 by Guérios et al.,<a class="elsevierStyleCrossRef" href="#bib0185">37</a> assessing the safety and efficacy of the ACP in patients with non-valvular AF (chronic or paroxysmal) with at least one additional risk factor for thromboembolism and contradiction or intolerance to chronic oral anticoagulation. The procedure was guided by angiography alone. Patients were prescribed clopidogrel for one month and aspirin for 3–4 months, or lifelong if there was significant coronary artery disease. TEE was performed before discharge and 3–6 months after implantation. Procedural success was obtained in 85 of the 86 treated patients (99%). The unsuccessful case was attributed to a patent foramen ovale (PFO) previously closed with an Amplatzer septal occluder; repeated attempts at implantation resulted in pericardial tamponade, resolved by pericardial drainage. Eighty-seven devices were implanted in the other 85 patients; in 81 of them success was achieved with the first device chosen, while in four the device had to be changed. In two patients LAA closure was incomplete; in one of them, an additional ACP was used, and an Amplatzer vascular plug in the other, with good final results.In 48 patients (55.8%) LAA closure was combined with another intervention, such as ASD closure, percutaneous coronary intervention, or transcatheter aortic valve implantation.One ACP embolization occurred about 15 minutes after being released during percutaneous coronary angioplasty; the device was retrieved and replaced by a smaller ACP. During the procedure, there was a pericardial effusion in one patient with no hemodynamic compromise, two ischemic cerebral events, one due to air embolism and the other probably thromboembolic, and one death six days after implantation due to bleeding from a gastrointestinal tumor. Follow-up was obtained in 69 of the remaining patients (a total of 25.9 patient-years), during which there were two deaths, one non-cardiovascular (bronchopneumonia) and the other cardiovascular, in a patient with three-vessel coronary disease. No other embolic events or peri-device leaks were observed, but a non-mobile thrombus was detected in six patients, which disappeared after oral anticoagulation for three months. In four patients, the presence of a fixed thrombus could not be ruled out; in one warfarin was prescribed for four months, no change being observed in the control TEE, and the other three remained on aspirin. After reviewing the results, the authors concluded that in 70% of cases with thrombi the device had been implanted more deeply than was desirable.The prospective randomized Amplatzer Cardiac Plug Clinical Trial is currently under way, comparing the efficacy of the ACP with warfarin in patients with AF and CHADS2 score ≥2, and without contraindication for oral coagulation.<a class="elsevierStyleCrossRef" href="#bib0190">38</a>The Watchman left atrial appendage systemThe Watchman device (Boston Scientific, Plymouth, MN) was designed specifically for percutaneous LAA closure. It consists of a self-expanding nitinol frame with fixation barbs around its perimeter and a porous polyester membrane only on the LA-facing surface (<a class="elsevierStyleCrossRef" href="#fig0015">Figure 3</a>). It is available in diameters of 21, 24, 27, 30 and 33mm, which should be 10–20% greater than the LAA orifice.<a class="elsevierStyleCrossRef" href="#bib0100">20</a><elsevierMultimedia ident="fig0015"></elsevierMultimedia>The first clinical trial, by Sick et al., aimed to assess the feasibility of this device for LAA closure.<a class="elsevierStyleCrossRef" href="#bib0100">20</a> It prospectively included 75 patients from centers in Europe and the US with a history of chronic or paroxysmal AF and CHADS2 score ≥1 without contradiction for oral anticoagulation.Following the procedure patients were medicated with aspirin (81–100mg daily), continued indefinitely, and warfarin for 45 days. Control TEE was performed at 45 days; if the LAA was successfully sealed according to the criteria of absence of flow or minimal flow around the device (jet of <3mm), warfarin was discontinued. The therapeutic regimen was later modified to include concomitant therapy with aspirin and 75mg clopidogrel between 45 days and the six-month follow-up.Closure was successful in 93% of cases (54 of 58). The first 16 patients received a first-generation device, which was associated with a significant number of complications including two device embolizations, one air embolism leading to a malignant arrhythmia requiring cardiopulmonary resuscitation, and one fractured delivery wire. The delivery system was subsequently modified and the device was redesigned; the second-generation device was used in 53 patients and no further embolizations occurred. Pericardial effusions occurred in two of the 75 cases (2.6%) related to the transseptal puncture procedure, one to an overly vigorous “tug test” usually performed for proof of stability of the device. The technique was modified to observe the LAA during the tug, either by fluoroscopy or TEE, and no further tug-related effusions were observed.No strokes occurred during the 24-month follow-up, compared with the expected rate of 1.9/year based on the CHADS2 score in this study cohort. Two cases of TIA occurred, one at four months without visible device thrombus and the other at six months with a smooth layer of thrombus detected on the surface of the device. Three more patients showed thrombus formation on the device surface without neurological symptoms. The authors concluded that the endothelialization process may not be completed at 45 days after implantation when warfarin is discontinued, so they modified the therapeutic regimen to include concomitant therapy with aspirin and clopidogrel between 45 days and the six-month follow-up.There were three major bleeding complications, two of which were pericardial effusions requiring pericardiocentesis, and one internal bleed due to retrieval after device embolization. There were minor bleeds in two patients.Two patients died during follow-up: one from dissection of the ascending aorta and the other from multiple organ failure after bowel surgery.The authors considered the results comparable to those reported for the PLAATO system, but with early results potentially biased by the use of a first-generation device and operator learning curves.The PROTECT AF trial,<a class="elsevierStyleCrossRefs" href="#bib0040">8,9</a> the first randomized clinical trial to directly compare percutaneous LAA closure (with the Watchman device) and warfarin, ran from February 2007 to June 2008, aiming to assess the non-inferiority of LAA closure in terms of efficacy and safety.<a class="elsevierStyleCrossRef" href="#bib0040">8</a>The study population consisted of 707 patients in 59 centers in Europe and the US with non-valvular paroxysmal, persistent or chronic AF, CHADS2 score of ≥1 and without contraindication to warfarin. They were randomly assigned in a 2:1 ratio to device implantation (463 patients; intervention group) or warfarin therapy (244; control group). Mean follow-up was 18 months.In the control group, the target INR of 2.0–3.0 was assessed every two weeks in the first six months, followed by monthly assessment. INR remained within the therapeutic range in 66% of measurements. In the intervention group warfarin was continued for 45 days after implantation in order to promote endothelization of the device. TEE was repeated at 45 days to verify successful closure (defined as no peri-device flow or flow <5mm wide (<3±2mm). If confirmed, warfarin was replaced by dual antiplatelet therapy with clopidogrel 75mg and aspirin 81–325mg for six months, followed by aspirin indefinitely. Follow-up consultations were scheduled for 45 days, six, nine and 12 months, and thenceforth twice a year. Neurological assessment was performed initially, at 12 and 24 months, and whenever a neurological event occurred.Implantation of the Watchman device was successful in 88% of patients (408/463) and in 91% of those in whom it was attempted (408/449). Warfarin was discontinued at 45 days in 86% of patients and at six months in 92%.Efficacy was assessed by a composite endpoint of ischemic stroke, hemorrhagic stroke, cardiovascular or unexplained death and systemic embolism. This occurred at a rate of 3%/year in the intervention group vs. 4.9%/year in the control group (rate ratio 0.62, 95% confidence interval 0.35–1.25), and the probability of non-inferiority of the intervention was more than 99.9%.The total number of strokes was higher in the control group, but the rate of ischemic stroke was higher in the intervention group: one before implantation, five during (due to air embolism), and nine after. Six ischemic strokes were observed in the control group. INR assessed at the time of the stroke was subtherapeutic in both groups.Hemorrhagic stroke was more common in the control group (6); five were fatal, all of which occurred with therapeutic warfarin levels. There was one hemorrhagic stroke under warfarin therapy in the intervention group.There were 21 deaths in the intervention group (4.5%), due to stroke (2; 0.4%), cardiovascular or unexplained (4; 0.9%), and non-cardiovascular (15; 3.2%). In the control group there were 18 deaths (7.4%), due to stroke (6; 2.4%), cardiovascular or unexplained (6; 2.4%), and non-cardiovascular (6; 2.4%). Cumulative mortality in the intervention group and control group was 3% vs. 3.1% at one year and 5.9% vs. 9.1% at two years, respectively.The safety composite endpoint was major bleeding (requiring transfusion of at least two units of packed red blood cells or surgical intervention) and procedure-related complications including stroke, device embolization or severe pericardial effusion requiring percutaneous or surgical drainage. These events were more frequent in the intervention group (7.4%/year vs. 4.4%/year) and earlier (55% on the day of the procedure vs. 50% between 45 days and one year) than in the control group. The most frequent safety event in the intervention group was severe pericardial effusion, seen in 4.8% of patients (n=22), requiring surgery in seven cases but resolved by pericardiocentesis in the others, with no associated mortality. The frequency of this complication, which was more common in the first three patients (7.1%) than in the others (4.4%) in all centers, declined as operator experience increased.There was device embolization in three patients; one was identified during the procedure and the device was successfully removed percutaneously, and two others were asymptomatic, only being detected by TEE after 45 days and removed surgically.The authors concluded that in terms of efficacy, percutaneous closure was not inferior to warfarin, even when patients at lower thromboembolic risk (CHADS2 score 1) were excluded. With regard to safety, the most common complications became less frequent as operators gained experience with the procedure, and none led to permanent disability or death. They suggested that the initial risk associated with device implantation was less than the cumulative risk of chronic warfarin therapy.The main limitation to applying these results to all AF patients was the inclusion of patients at low embolic risk (65% with CHADS2 score 1 or 2). It is not known to what extent they would be reproducible in a higher-risk population, particularly with contraindication for warfarin.In view of these findings, the FDA recommended a longer follow-up period and an ongoing registry was established to assess the safety of LAA closure with the Watchman device – the Continued Access Protocol (CAP) Registry.<a class="elsevierStyleCrossRef" href="#bib0195">39</a>This registry, published in January 2011, included the 542 patients who underwent attempted LAA device closure in the intervention group of the PROTECT AF trial and a further 460 patients from 26 centers that participated in the trial with the same inclusion criteria, follow-up and medication. The authors emphasized the importance of flushing the sheath with saline to minimize the chance of air embolism.Median follow-up was 2.5 years for PROTECT AF (0–4.7 years) and 0.4 years for CAP (0–1.6 years).The efficacy composite endpoint was similar to that of PROTECT AF. Pericardial effusions were considered serious if they extended hospitalization.The populations of the two studies differed mainly in age and CHADS2 score, which were higher in CAP (mean age 74±8 vs. 72±9 and CHADS2 score 2.4±1.2 vs. 2.2±1.2, p<0.001 for both).To assess the effect of the learning curve and operator experience, the results of CAP and PROTECT AF were compared, and the first half of the PROTECT AF patient cohort was compared with the second half of the cohort, as well as the first three patients enrolled at each site in PROTECT AF with all subsequent patients enrolled at that site. There was a reduction in mean procedure time, an increase in implantation success, and a decline in the number of safety events, serious pericardial effusions and procedural stroke between the first and second halves of PROTECT AF and between the second half of PROTECT AF and CAP (<a class="elsevierStyleCrossRef" href="#tbl0025">Table 5</a>), the event rate in the second half of PROTECT AF (5.5%) being close to that seen in CAP (3.7%). Comparing the first three patients with all subsequent patients at each site, mean procedure time improved by 33% and the safety event rate improved by 52% (<a class="elsevierStyleCrossRef" href="#tbl0025">Table 5</a>).<elsevierMultimedia ident="tbl0025"></elsevierMultimedia>The time dependence of safety events was assessed by separating those that occurred within seven days of the procedure from those in the remainder of follow-up; overall, 94% of these events occurred in the first seven days (91% in PROTECT AF and 100% in CAP). Serious pericardial effusion was observed in 3.8% of patients (5.2% in PROTECT AF and 2.2% in CAP). The procedure-related stroke rate was 0.9% in PROTECT AF and zero in CAP. In PROTECT AF, device embolization occurred in 0.6% of patients vs. 0% in CAP. Device-associated thrombus was observed in 4.2% (20) of patients in PROTECT AF and in none in CAP.Another important analysis of the PROTECT AF results was to determine the functional impact of adverse events, identifying those that resulted in death or significant disability (defined as an increase in the modified Rankin score). This analysis revealed that regardless of how “significant” is defined (change in Rankin score of ≥1, ≥2 or ≥3), the safety event rate with functional impact was lower in the intervention group than in the control group, with a relative risk of ≈0.40 (<a class="elsevierStyleCrossRef" href="#tbl0030">Table 6</a>).<elsevierMultimedia ident="tbl0030"></elsevierMultimedia>The authors concluded that safety events in the Watchman group were largely procedure-related, that these safety events decreased in frequency with greater operator experience, and that they led to less significant disability than those related to warfarin therapy, which accumulate linearly over time.<a class="elsevierStyleCrossRef" href="#bib0195">39</a>The protocols of both PROTECT AF and the CAP registry included a 45-day period of warfarin medication after percutaneous LAA closure, which limits their application to patients with contraindication to oral anticoagulation, for whom this procedure could be an alternative. The ASA Plavix Feasibility Study With WATCHMAN Left Atrial Appendage Closure Technology (ASAP),<a class="elsevierStyleCrossRef" href="#bib0200">40</a> a prospective non-randomized registry, was set up to assess the efficacy of percutaneous LAA closure in these patients. It has the same inclusion and exclusion criteria as PROTECT AF, except for contraindication to warfarin, and includes 150 patients with non-valvular AF in three centers in Germany and one in the Czech Republic who underwent percutaneous closure with the Watchman device. After the procedure patients took clopidogrel for six months and aspirin indefinitely, and underwent TEE at three and 12 months. Preliminary results were presented at the Heart Rhythm Society 2012 Scientific Sessions.<a class="elsevierStyleCrossRef" href="#bib0205">41</a> Implantation was successful in 94% of patients (141/150). In a follow-up of 14.2±8.7 months there was one systemic embolization, six cases of device-related thrombus and four strokes, an ischemic stroke rate of 1.8%, which according to the authors corresponds to a 75% reduction in events compared to that expected on the basis of a mean CHADS2 score of 2.8±1.2 if they had been taking aspirin alone (7.1%) and a 64% reduction compared to that expected under treatment with aspirin and clopidogrel indefinitely (5%). The authors concluded that implantation of the Watchman device was safe and effective without temporary warfarin therapy in patients with contraindication to oral anticoagulation.<a class="elsevierStyleCrossRef" href="#bib0205">41</a>Incomplete closure of the LAA by surgical methods increases risk for embolic events, but it was not known whether this was also true of incomplete percutaneous closure. Viles-Gonzalez et al. accordingly performed a retrospective analysis of the intervention group of PROTECT AF, published in March 2012.<a class="elsevierStyleCrossRef" href="#bib0210">42</a> They assessed peri-device blood flow, classified as minor, moderate, or major (<1mm, 1–3mm, and >3mm, respectively), by TEE at 45 days, six and 12 months. Of the 485 patients with a successfully implanted Watchman device, only 445 underwent TEE at 45 days, 414 at six months and 389 at 12 months. The prevalence of any flow around the device decreased with time from 40.9% at the 45-day TEE, to 33.8% at six months, and to 32.1% at 12 months (p=0.001). The severity of the flow at 45 days was minor in 7.7%, moderate in 59.9% and major in 32.4%; this distribution did not change significantly at six or 12 months (p=0.731). The mean and maximum width of the leak were 2.8 and 6.2mm, 2.9 and 6.8mm, and 2.9 and 6.0mm, at 45 days, six months, and 12 months, respectively.There were no significant differences in the efficacy endpoint of PROTECT AF between patients with peri-device flow (2.8%) and those without (2%; p=0.635), or between those with any flow and no flow (hazard ratio [HR] 0.85, 0.83 and 0.48 for minor, moderate and major flow, respectively, p=0.798). The impact of 1-mm increases in flow size on this endpoint was also analyzed and there was no significant difference between the groups (HR 0.84, p=0.256).Analysis of a second endpoint of stroke and systemic embolization again showed no significant relationship with the presence or severity of peri-device flow.This analysis was also performed separately for patients who continued warfarin therapy after 45 days and those who discontinued it at that point, once again without showing any difference regarding the presence of peri-device flow (p=0.857).The authors concluded that in this sample there was no relationship between the presence of residual peri-device flow and embolic events, although with the caveat that these results may not be applicable to devices other than the Watchman, and suggest that different devices should be analyzed in the same way.<a class="elsevierStyleCrossRef" href="#bib0210">42</a>A second randomized clinical trial on the Watchman device is under way, the PREVAIL study.<a class="elsevierStyleCrossRef" href="#bib0215">43</a> This has a similar structure to PROTECT AF, except that patients with CHADS2 score of 1 are only included if any of the following apply: female age 75 or older; left ventricular ejection fraction ≥30 and <35%, aged 65–74 and has diabetes or coronary artery disease, or aged ≥65 and has congestive heart failure.ConclusionsThe development of percutaneous LAA closure was an important step in the prevention of cardioembolic events in AF, particularly in non-valvular AF. The feasibility of the technique has been demonstrated in various studies, the most important of which, PROTECT AF, showed similar efficacy to warfarin in prevention of thromboembolic events, although with a higher rate of safety events, particularly procedure-related. Longer follow-up of these patients and the establishment of the CAP registry have produced encouraging results for continued use of the technique, since they show that procedure-related complications decline with greater operator experience and lead to lower mortality and disability than warfarin therapy, suggesting that LAA closure has a better long-term safety profile.These findings demonstrate that percutaneous LAA closure is a valid alternative for thromboembolic prevention in high-risk patients with non-valvular AF without contraindication for oral anticoagulation, although it has mainly been used in patients in whom anticoagulation is contraindicated, for obvious reasons. However, reports of a particularly serious complication – the formation of thrombi on the device – have cooled the initial enthusiasm generated by the technique and raised the possibility that a period of anticoagulation may be necessary after implantation in some patients.Unlike the data on incomplete surgical LAA occlusion, incomplete closure with the Watchman device was not associated with embolic events in the only trial performed to date.Although further studies are needed to assess possible late complications related to these devices and to determine any physiological consequences of LAA closure (about which little is known), percutaneous LAA closure appears to be a safe and effective alternative to oral anticoagulation in high-risk patients, and may also become a valid alternative for low-risk patients. The role of new oral anticoagulants in thromboembolic prevention will also be important in determining which patients would benefit from percutaneous LAA closure.Ethical disclosuresProtection of human and animal subjectsThe authors declare that no experiments were performed on humans or animals for this study.Confidentiality of dataThe authors declare that no patient data appear in this article.Right to privacy and informed consentThe authors declare that no patient data appear in this article.Conflicts of interestThe authors have no conflicts of interest to declare." "textoCompletoSecciones" => array:1 [ "secciones" => array:20 [ 0 => array:2 [ "identificador" => "xres251697" "titulo" => "Abstract" ] 1 => array:2 [ "identificador" => "xpalclavsec239294" "titulo" => "Keywords" ] 2 => array:2 [ "identificador" => "xres251698" "titulo" => "Resumo" ] 3 => array:2 [ "identificador" => "xpalclavsec239295" "titulo" => "Palavras-chave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Prevalence of atrial fibrillation" ] 6 => array:2 [ "identificador" => "sec0015" "titulo" => "The importance of thromboembolism in atrial fibrillation" ] 7 => array:2 [ "identificador" => "sec0020" "titulo" => "Chronic anticoagulation with warfarin" ] 8 => array:2 [ "identificador" => "sec0025" "titulo" => "New oral anticoagulants" ] 9 => array:2 [ "identificador" => "sec0030" "titulo" => "The importance of the left atrial appendage in thromboembolism" ] 10 => array:2 [ "identificador" => "sec0035" "titulo" => "Surgical exclusion of the LAA" ] 11 => array:2 [ "identificador" => "sec0040" "titulo" => "Minimally invasive LAA exclusion" ] 12 => array:2 [ "identificador" => "sec0045" "titulo" => "Endocardial percutaneous LAA closure" ] 13 => array:2 [ "identificador" => "sec0050" "titulo" => "The PLAATO device" ] 14 => array:2 [ "identificador" => "sec0055" "titulo" => "Amplatzer devices" ] 15 => array:2 [ "identificador" => "sec0060" "titulo" => "The Watchman left atrial appendage system" ] 16 => array:2 [ "identificador" => "sec0065" "titulo" => "Conclusions" ] 17 => array:3 [ "identificador" => "sec0070" "titulo" => "Ethical disclosures" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0075" "titulo" => "Protection of human and animal subjects" ] 1 => array:2 [ "identificador" => "sec0080" "titulo" => "Confidentiality of data" ] 2 => array:2 [ "identificador" => "sec0085" "titulo" => "Right to privacy and informed consent" ] ] ] 18 => array:2 [ "identificador" => "sec0090" "titulo" => "Conflicts of interest" ] 19 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2012-03-18" "fechaAceptado" => "2012-06-18" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec239294" "palabras" => array:6 [ 0 => "Atrial fibrillation" 1 => "Thromboembolism" 2 => "Stroke" 3 => "Left atrial appendage" 4 => "Anticoagulation" 5 => "Cardiac implant" ] ] ] "pt" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palavras-chave" "identificador" => "xpalclavsec239295" "palabras" => array:6 [ 0 => "Fibrilhação auricular" 1 => "Tromboembolismo" 2 => "Acidente vascular cerebral" 3 => "Apêndice auricular esquerdo" 4 => "Anticoagulação oral" 5 => "Implante cardíaco" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "Atrial fibrillation is a common arrhythmia in clinical practice. It is associated with high morbidity and mortality due to its thromboembolic potential, which makes thromboembolic prevention particularly important. Warfarin has been the first-line therapy for this purpose, but it has various limitations and is often contraindicated or underutilized. The fact that thrombi are frequently located in the left atrial appendage in atrial fibrillation led to the development of percutaneous closure for thromboembolic prevention. This article examines the current evidence on percutaneous closure of the left atrial appendage by reviewing the results of the numerous clinical trials on the technique." ] "pt" => array:2 [ "titulo" => "Resumo" "resumen" => "A fibrilhação auricular é uma arritmia frequente na prática clínica. Associa-se à morbilidade e à mortalidade elevadas, em virtude do seu potencial tromboembólico, o que confere especial relevância à profilaxia do tromboembolismo. Para este efeito, a varfarina tem sido a terapêutica de primeira linha, no entanto, associa-se a inúmeras limitações, que a tornam contraindicada ou sub-utilizada. A localização frequente no apêndice auricular esquerdo dos trombos formados na fibrilhação auricular conduziu a que o seu encerramento percutâneo fosse desenvolvido para profilaxia do tromboembolismo. Este artigo pretende fazer um enquadramento da evidência atual para o encerramento percutâneo do apêndice auricular esquerdo, através de uma revisão e atualização dos resultados dos inúmeros estudos realizados até ao momento." ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "Please cite this article as: Faustino A, et al. Encerramento percutâneo do apêndice auricular esquerdo para profilaxia de tromboembolismo na fibrilhação auricular. Rev Port Cardiol. 2013. http://dx.doi.org/10.1016/j.repc.2012.06.017." ] ] "multimedia" => array:9 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 823 "Ancho" => 1425 "Tamanyo" => 47066 ] ] "descripcion" => array:1 [ "en" => "The PLAATO device (ev3 Inc., Plymouth, MN). LA: left atrium; LAA: left atrial appendage. Adapted from<a class="elsevierStyleCrossRef" href="#bib0135">27</a>." ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 797 "Ancho" => 1667 "Tamanyo" => 63908 ] ] "descripcion" => array:1 [ "en" => "The Amplatzer Cardiac Plug (St. Jude Medical, Plymouth, MN). Adapted from<a class="elsevierStyleCrossRef" href="#bib0160">32</a>." ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 750 "Ancho" => 1394 "Tamanyo" => 43186 ] ] "descripcion" => array:1 [ "en" => "The Watchman device (Boston Scientific, Plymouth, MN). Adapted from<a class="elsevierStyleCrossRef" href="#bib0045">9</a>." ] ] 3 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "fuente" => "Adapted from<a class="elsevierStyleCrossRef" href="#bib0140">28</a>." "tabla" => array:2 [ "leyenda" => "LAA: left atrial appendage." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Degree of occlusion/type of leak \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Flow on angiography \t\t\t\t\t\t\n \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1: Severe \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Completely fills the LAA \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2: Moderate \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Fills two-thirds of the LAA \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3: Mild \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Fills one-third of the LAA \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4: Trace or absent \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Barely detectable or no blush \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab355033.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Angiographic classification of left atrial appendage closure. Successful closure was defined by a leak of degree 3 or 4." ] ] 4 => array:8 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "fuente" => "Adapted from<a class="elsevierStyleCrossRef" href="#bib0140">28</a>." "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Degree of occlusion/type of leak \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Color Doppler flow \t\t\t\t\t\t\n \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1: Severe \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Multiple jets of free flow \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2: Moderate \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">>3mm diameter jet \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3: Mild \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1–3mm diameter jet \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4: Trace leak \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><1mm diameter jet \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5: Absent leak \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">No jet \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab355031.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Classification of LAA closure by color Doppler echocardiography. Successful LAA occlusion was defined as a grade of 3 or higher." ] ] 5 => array:7 [ "identificador" => "tbl0015" "etiqueta" => "Table 3" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:2 [ "leyenda" => "AF: atrial fibrillation; CAD: coronary artery disease; LAA: left atrial appendage; OAC: oral anticoagulation; TEE: transesophageal echocardiography; TIA; transient ischemic attack; TTE: transthoracic echocardiography.aTTE criteria – flow velocity in the LAA <20cm/s or moderate or dense spontaneous echocardiographic contrast.bRequiring treatment (pericardiocentesis or surgery)." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Trial \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Sievert et al.<a class="elsevierStyleCrossRef" href="#bib0135">27</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Ostermayer et al.<a class="elsevierStyleCrossRef" href="#bib0140">28</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Park et al.<a class="elsevierStyleCrossRef" href="#bib0145">29</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Block et al.<a class="elsevierStyleCrossRef" href="#bib0150">30</a> \t\t\t\t\t\t\n \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Design \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Prospective1 centerEurope \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Prospective5 centersEurope+N. America \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Prospective1 centerEurope \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Prospective10 centersN. America \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Year of publication \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2002 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2005 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2009 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2009 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Sample size (n) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">15 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">111 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">73 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">64 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Inclusion criteria \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">- Chronic non-rheumatic AF- High TE risk (CHADS2 score ≥1 or spontaneous echo contrast in the LAA)- Contraindication to OAC \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">- Non-rheumatic AF ≥3 months duration- High TE risk (≥1 in Europe or ≥2 in N. America: CAD, CHADS2 score or TEE criteria*)- Contraindication to OAC \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">- Rheumatic or non-rheumatic chronic or paroxysmal AF- Contraindication to OAC or embolic stroke under OAC \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">- Non-valvular chronic or paroxysmal AF- CHADS2 score ≥2- Contraindication to OAC \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">CHADS2score \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Not specified \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2.5±2.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2.5±1.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2.6 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Post-procedural medication \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">- Aspirin 300mg/day indefinitely- Clopidogrel 75mg/day 6 months \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">- Aspirin 300–325mg/day indefinitely- Clopidogrel 75mg/day N. America – 1.5 months; Europe – decision of investigator- Prophylaxis against endocarditis: 6 months in N. America \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">- Aspirin 100mg/day indefinitely- Clopidogrel 75mg/day 6 months \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">- Aspirin 325mg/day indefinitely- Clopidogrel 75mg/day 1–1.5 months \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Device changed \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4 (26.7%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Not specified \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">9 (12.3%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 (1.6%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Implantation success \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">15 (100%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">108 (97.3%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">71 (97.3%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">61 (93.85%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Procedure time \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">90min \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">68min \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Not specified \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Not specified \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="5" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"></td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="5" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Follow-up</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">- Type \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">- TEE and chest X-ray \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">- TEE (3–6 months)- Interview at 24 months \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">- TEE: 1, 6 months: 20 patients; TTE: others- Interview, lab. tests and chest X-ray: 1, 3, 6, 12, 24, 36, 48, and 60 months \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">- Duration \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 month \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">10 months \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">24 months \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3.75 years \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="5" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"></td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Stroke/TIA \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 (0%)/0 (0%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 (1.8%)/3 (2.7%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 (1.4%)/0 (0%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">8 (12.5%)/1 (1.6%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="5" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"></td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="5" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Stroke+TIA/year</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">- Observed \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Not specified \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2.2% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.4% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3.8% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">- Predicted(CHADS2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Not specified \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">6.3% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5.0% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">6.6% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="5" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"></td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Device embolization \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 (0%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 (0%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 (1.4%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 (0%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Pericardial effusionb \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 (6.7%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5 (4.5%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 (0%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 (1.6%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="5" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"></td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="5" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Mortality</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">- Procedural \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 (0%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 (0%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 (1.4%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 (0%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">- Non-procedural \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 (0%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">6 (5.4%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">10 (13.7%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">17 (26.6%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="5" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"></td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Device thrombus \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 (0%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 (0.9%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 (0%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 (0%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Surgery for procedural complications \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 (0%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 (0.9%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 (1.4%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 (1.6%) \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab355029.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Characteristics and results of the main clinical trials on the PLAATO device (ev3, Inc., Plymouth, MN)." ] ] 6 => array:7 [ "identificador" => "tbl0020" "etiqueta" => "Table 4" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:2 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Trial \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Meier et al.<a class="elsevierStyleCrossRef" href="#bib0155">31</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Park et al.<a class="elsevierStyleCrossRef" href="#bib0160">32</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Sick et al.<a class="elsevierStyleCrossRef" href="#bib0100">20</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Holmes et al. (PROTECT-AF)<a class="elsevierStyleCrossRef" href="#bib0040">8</a> \t\t\t\t\t\t\n \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Device \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">ASO \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">ACP \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Watchman \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Watchman \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Design \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Prospective4 centersEurope and N. America \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Retrospective10 centersEurope \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Prospective7 centersEurope and N. America \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Prospective, randomized, controlled59 centersEurope and US \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Year of publication \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2003 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2009 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2007 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2009 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Inclusion criteria \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">- Chronic or paroxysmal AF- Others not specified \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">- Chronic or paroxysmal AF- Others not specified \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">- Chronic or paroxysmal AF- CHADS2 score ≥1- Eligible for OAC \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">- Age >18- Non-valvular chronic, persistent or paroxysmal AF- CHADS2 score ≥1- Eligible for OAC \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">CHADS2score \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Not specified \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Not specified \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Not specified \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Not specified \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Planned implantations \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">16 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">143 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">75 (1st gen.: 16; 2nd gen.: 59) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">449/463 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Devices implanted \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">16 (100%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">137 (95.8%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1st gen.: 14/16 (87.5%)2nd gen.: 53/59 (89.8%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">408/449 (intervention group) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Device changed \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 (0%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">23/137 (16.8%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Not specified \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Not specified \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Implantation success \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">15 (93.8%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">132/137 (96%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1st gen.: 13/14 (92.8%)2nd gen.: 53/53 (100%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">408/449 (90.9%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Procedure time \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Not specified \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Not specified \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Not specified \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Not specified \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Device embolization \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 (6.2%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2/137 (1.4%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1st gen.: 2/14 (14.3%)2nd gen.: 0/53 (0%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3/449 (0.7%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Pericardial effusion<a class="elsevierStyleCrossRef" href="#tblfn0005">a</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 (0%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5/137 (3.6%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1st gen.: 1/14 (7.1%)2nd gen.: 1/53 (1.9%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">22/449 (4.9%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Device thrombus \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 (0%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Not specified \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1st gen.: 0/14 (0%)2nd gen.: 4/53 (7.5%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Not specified \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Post-procedural medication \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">- 1 center: warfarin for 6 weeks \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Not specified \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">- Aspirin (81–100mg/day) indefinitely- Warfarin 45 days- Later patients: clopidogrel 75mg/day from 45th day to 6 months \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">- Aspirin (81–325mg/day) indefinitely- Warfarin 45 days- Clopidogrel 75mg/day from 45th day to 6 months \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="5" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"></td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="5" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Follow-up</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">- Type \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">- TEE \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Not specified \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">- TEE at 45 days, 6 months, then annually until 5 years \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">- TEE at 45 days- Clinical: at 45 days, 6, 9, and 12 months, then twice yearly- Neurological: initial, 6, 9, and 12 months, then twice yearly \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">- Duration \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4 months \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Not specified \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">24 months \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">18 months \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="5" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"></td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Stroke/TIA \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 (0%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3 (2.2%)/0 (0%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 (0%)/2 (2.7%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">15/694.6 (2.2%)/not specified \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="5" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"></td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="5" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Stroke+TIA/year</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">- Observed \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 (0%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Not specified \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Not specified \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Not specified \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">- Predicted (CHADS2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Not specified \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Not specified \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.9% stroke/year \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Not specified \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="5" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"></td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="5" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Mortality</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">- Procedural \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 (0%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Not specified \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 (0%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2/463 (0.4%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">- Non-procedural \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 (0%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Not specified \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2/75 (2.7%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">19/463 (4.1%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="5" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"></td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Surgery for procedural complications \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 (6.2%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 (0%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1st gen.: 1/14 (7.1%)2nd gen.: 0/53 (0%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">8/449 (1.8%) \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab355034.png" ] ] ] "notaPie" => array:1 [ 0 => array:3 [ "identificador" => "tblfn0005" "etiqueta" => "a" "nota" => "Requiring treatment (pericardiocentesis or surgery). 1st gen.: first-generation device; 2nd gen.: second-generation device; ACP: Amplatzer Cardiac Plug; AF: atrial fibrillation; ASO: Amplatzer septal occulder; OAC: oral anticoagulation; TEE: transesophageal echocardiography; TIA: transient ischemic attack." ] ] ] "descripcion" => array:1 [ "en" => "Characteristics and results of the main clinical trials on the Amplatzer (St. Jude Medical, Plymouth, MN) and Watchman (Boston Scientific, Plymouth, MN) devices." ] ] 7 => array:8 [ "identificador" => "tbl0025" "etiqueta" => "Table 5" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "fuente" => "Adapted from <a class="elsevierStyleCrossRef" href="#bib0195">39</a>." "tabla" => array:2 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">PROTECT AF \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " colspan="2" align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">PROTECT AF</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " colspan="2" align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">PROTECT AF</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">CAP \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">p<a class="elsevierStyleCrossRef" href="#tblfn0010">a</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">p<a class="elsevierStyleCrossRef" href="#tblfn0015">b</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">p<a class="elsevierStyleCrossRef" href="#tblfn0020">c</a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">1st half \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">2nd half \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">1st three patients \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Subsequent \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Procedure time (min) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">62±34 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">67±36 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">58±33 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">82±40 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">55±29 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">50±21 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><0.001 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><0.001 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><0.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Implantation success \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">485/542 (89.5%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">239/271 (88.2%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">246/271 (90.8%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">133/154 (86.4%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">352/388 (90.7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">437/460 (95.0%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.001 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.001 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.136 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Safety events in the 1st 7 days \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">42/542 (7.7%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">27/271 (10.0%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">15/271 (5.5%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">19/154 (12.3%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">23/388 (5.9%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">17/460 (3.7%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.007 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.006 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.012 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Serious pericardial effusion in the 1st 7 days \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">27/542 (5.0%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">17/271 (6.3%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">10/271 (3.7%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">10/154 (6.5%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">17/388 (4.4%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">10/460 (2.2%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.019 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.018 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.308 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Procedure-related stroke \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5/542 (0.9%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3/271 (1.1%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2/271 (0.7%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1/154 (0.7%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4/388 (1.0%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0/460 (0%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.039 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.039 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.675 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab355032.png" ] ] ] "notaPie" => array:3 [ 0 => array:3 [ "identificador" => "tblfn0010" "etiqueta" => "a" "nota" => "For comparison between PROTECT AF and CAP." ] 1 => array:3 [ "identificador" => "tblfn0015" "etiqueta" => "b" "nota" => "For comparison between the three groups PROTECT AF 1st half, PROTECT AF 2nd half, and CAP." ] 2 => array:3 [ "identificador" => "tblfn0020" "etiqueta" => "c" "nota" => "For comparison between the first three patients and subsequent patients at each site." ] ] ] "descripcion" => array:1 [ "en" => "Safety events in PROTECT AF and CAP, adapted from<a class="elsevierStyleCrossRef" href="#bib0195">39</a>. Results expressed in n/total (%); p values obtained by the chi-square test or ANOVA." ] ] 8 => array:8 [ "identificador" => "tbl0030" "etiqueta" => "Table 6" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "fuente" => "Adapted from <a class="elsevierStyleCrossRef" href="#bib0195">39</a>." "tabla" => array:2 [ "leyenda" => "CI: confidence interval; MRS: modified Rankin score." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Intervention groupn/total (%/year) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Control groupn/total year) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Relative risk (95% CI) \t\t\t\t\t\t\n \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Death or MRS≥1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">19/1042.2 (1.8%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">24/559.5 (4.3%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.43 (0.24–0.82) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Death or MRS≥2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">16/1047.1 (1.5%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">21/563.9 (3.7%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.41 (0.22–0.82) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Death or MRS≥3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">15/1048.5 (1.4%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">19/567.5 (3.3%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.43 (0.22–0.88) \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab355030.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Functional impact of safety events in PROTECT AF." ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:43 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Prevalência de fibrilhação auricular na população portuguesa com 40 ou mais anos. Estudo FAMA" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "D. Bonhorst" 1 => "M. Mendes" 2 => "P. Adragão" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Rev Port Cardiol" "fecha" => "2010" "volumen" => "29" "paginaInicial" => "331" "paginaFinal" => "350" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20635561" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Guidelines for the management of atrial fibrillation: The Task Force for the Management of AtrialFibrillation of the European Society of Cardiology (ESC)" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "A.J. Camm" 1 => "P. Kirchhof" 2 => "G.Y. Lip" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1093/eurheartj/ehq278" "Revista" => array:6 [ "tituloSerie" => "Eur Heart J" "fecha" => "2010" "volumen" => "31" "paginaInicial" => "2369" "paginaFinal" => "2429" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20802247" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0015" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Outcome parameters for trials in atrial fibrillation: executive summary" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "P. Kirchhof" 1 => "A. Auricchio" 2 => "J. Bax" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1093/eurheartj/ehm358" "Revista" => array:6 [ "tituloSerie" => "Eur Heart J" "fecha" => "2007" "volumen" => "28" "paginaInicial" => "2803" "paginaFinal" => "2817" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17897924" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0020" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Left atrial appendage closure in atrial fibrillation: a world without anticoagulation?" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "T. Contractor" 1 => "A. Khasnis" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Cardiol Res Pract" "fecha" => "2011" "volumen" => "2011" "paginaInicial" => "752" "paginaFinal" => "808" ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0025" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Percutaneous closure of the left atrial appendage: a major step forward" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "H. Sievert" 1 => "Y.L. Bayard" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jcin.2009.05.013" "Revista" => array:6 [ "tituloSerie" => "JACC Cardiovasc Interv" "fecha" => "2009" "volumen" => "2" "paginaInicial" => "601" "paginaFinal" => "602" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19628180" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0030" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Stroke in paroxysmal atrial fibrillation: report from the Stockholm Cohort of Atrial Fibrillation" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "L. Friberg" 1 => "N. Hammar" 2 => "M. Rosenqvist" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1093/eurheartj/ehn599" "Revista" => array:6 [ "tituloSerie" => "Eur Heart J" "fecha" => "2010" "volumen" => "31" "paginaInicial" => "967" "paginaFinal" => "975" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19176537" "web" => "Medline" ] ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0035" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Meta-analysis: antithrombotic therapy to prevent stroke in patients who have nonvalvular atrial fibrillation" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "R.G. Hart" 1 => "L.A. Pearce" 2 => "M.I. Aguilar" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Ann Intern Med" "fecha" => "2007" "volumen" => "146" "paginaInicial" => "857" "paginaFinal" => "867" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17577005" "web" => "Medline" ] ] ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0040" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Percutaneous closure of the left atrial appendage versus warfarin therapy for prevention of stroke in patients with atrial fibrillation: a randomized non-inferiority trial" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "D.R. Holmes" 1 => "V.Y. Reddy" 2 => "Z.G. Turi" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/S0140-6736(09)61343-X" "Revista" => array:6 [ "tituloSerie" => "Lancet" "fecha" => "2009" "volumen" => "374" "paginaInicial" => "534" "paginaFinal" => "542" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19683639" "web" => "Medline" ] ] ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0045" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The PROTECT AF (WATCMAN Left Atrial Appendage System for Embolic PROTECTion in Patients with Atrial Fibrillation) trial" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "R.B. Fountain" 1 => "D.R. Holmes" 2 => "K. Chandrasekaran" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.ahj.2006.02.005" "Revista" => array:6 [ "tituloSerie" => "Am Heart J" "fecha" => "2006" "volumen" => "151" "paginaInicial" => "956" "paginaFinal" => "961" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16644311" "web" => "Medline" ] ] ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib0050" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Effect of clopidogrel added to aspirin in patients with atrial fibrillation" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "S.J. Connolly" 1 => "J. Progue" 2 => "R.G. Hart" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1056/NEJMoa0901301" "Revista" => array:6 [ "tituloSerie" => "N Engl J Med" "fecha" => "2009" "volumen" => "360" "paginaInicial" => "2066" "paginaFinal" => "2078" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19336502" "web" => "Medline" ] ] ] ] ] ] ] ] 10 => array:3 [ "identificador" => "bib0055" "etiqueta" => "11" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Clopidogrel plus aspirin versus oral anticoagulation for atrial fibrillation in the Atrial fibrillation Clopidogrel Trial with Irbesartan for prevention of Vascular Events (ACTIVE W): a randomized controlled trial" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "S. Connolly" 1 => "J. Progue" 2 => "R. Hart" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/S0140-6736(06)68845-4" "Revista" => array:6 [ "tituloSerie" => "Lancet" "fecha" => "2006" "volumen" => "367" "paginaInicial" => "1903" "paginaFinal" => "1912" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16765759" "web" => "Medline" ] ] ] ] ] ] ] ] 11 => array:3 [ "identificador" => "bib0060" "etiqueta" => "12" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Left atrial appendage exclusion for stroke prevention in patients with nonrheumatic atrial fibrillation" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "O. Onalan" 1 => "E. Crystal" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1161/01.STR.0000250166.06949.95" "Revista" => array:6 [ "tituloSerie" => "Stroke" "fecha" => "2007" "volumen" => "38" "paginaInicial" => "624" "paginaFinal" => "630" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17261703" "web" => "Medline" ] ] ] ] ] ] ] ] 12 => array:3 [ "identificador" => "bib0065" "etiqueta" => "13" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Dabigatran versus warfarin in patients with atrial fibrillation" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "S.J. Connolly" 1 => "M.D. Ezekowitz" 2 => "S. Yusuf" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1056/NEJMoa0905561" "Revista" => array:6 [ "tituloSerie" => "N Engl J Med" "fecha" => "2009" "volumen" => "361" "paginaInicial" => "1139" "paginaFinal" => "1151" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19717844" "web" => "Medline" ] ] ] ] ] ] ] ] 13 => array:3 [ "identificador" => "bib0070" "etiqueta" => "14" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Rivaroxaban versus warfarin in nonvalvular atrial fibrillation" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "M.R. Patel" 1 => "K.W. Mahaffey" 2 => "J. Garg" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1056/NEJMoa1009638" "Revista" => array:6 [ "tituloSerie" => "N Engl J Med" "fecha" => "2011" "volumen" => "365" "paginaInicial" => "883" "paginaFinal" => "891" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21830957" "web" => "Medline" ] ] ] ] ] ] ] ] 14 => array:3 [ "identificador" => "bib0075" "etiqueta" => "15" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Apixaban versus warfarin in patients with atrial fibrillation" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "C.B. Granger" 1 => "J.H. Alexander" 2 => "J.J. McMurray" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1056/NEJMoa1107039" "Revista" => array:6 [ "tituloSerie" => "N Engl J Med" "fecha" => "2011" "volumen" => "365" "paginaInicial" => "981" "paginaFinal" => "992" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21870978" "web" => "Medline" ] ] ] ] ] ] ] ] 15 => array:3 [ "identificador" => "bib0080" "etiqueta" => "16" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Stroke prevention in atrial fibrillation: atrial appendage closure" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "C.J. Fuller" 1 => "M. Reisman" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s11886-010-0162-1" "Revista" => array:6 [ "tituloSerie" => "Curr Cardiol Rep" "fecha" => "2011" "volumen" => "13" "paginaInicial" => "159" "paginaFinal" => "166" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21225480" "web" => "Medline" ] ] ] ] ] ] ] ] 16 => array:3 [ "identificador" => "bib0085" "etiqueta" => "17" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Canadian Cardiovascular Society Atrial Fibrillation Guidelines 2010: prevention of stroke and systemic thromboembolism in atrial fibrillation and flutter" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "J.A. Cairns" 1 => "S. Connolly" 2 => "S. McMurtry" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.cjca.2010.11.007" "Revista" => array:6 [ "tituloSerie" => "Can J Cardiol" "fecha" => "2011" "volumen" => "27" "paginaInicial" => "74" "paginaFinal" => "90" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21329865" "web" => "Medline" ] ] ] ] ] ] ] ] 17 => array:3 [ "identificador" => "bib0090" "etiqueta" => "18" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Appendage obliteration to reduce stroke in cardiac surgical patients with atrial fibrillation" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "J.L. Blackshear" 1 => "J.A. Odell" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/0003-4975(95)00887-X" "Revista" => array:6 [ "tituloSerie" => "Ann Thorac Surg" "fecha" => "1996" "volumen" => "61" "paginaInicial" => "755" "paginaFinal" => "759" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8572814" "web" => "Medline" ] ] ] ] ] ] ] ] 18 => array:3 [ "identificador" => "bib0095" "etiqueta" => "19" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Use of transesophageal echocardiography to guide cardioversion in patients with atrial fibrillation" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "A.L. Klein" 1 => "R.A. Grimm" 2 => "R.D. Murray" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1056/NEJM200105103441901" "Revista" => array:6 [ "tituloSerie" => "N Engl J Med" "fecha" => "2001" "volumen" => "344" "paginaInicial" => "1411" "paginaFinal" => "1420" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11346805" "web" => "Medline" ] ] ] ] ] ] ] ] 19 => array:3 [ "identificador" => "bib0100" "etiqueta" => "20" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Initial worldwide experience with the WATCHMAN left atrial appendage system for stroke prevention in atrial fibrillation" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "P.B. Sick" 1 => "G. Schuler" 2 => "K.E. Hauptmann" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jacc.2007.02.035" "Revista" => array:6 [ "tituloSerie" => "J Am Coll Cardiol" "fecha" => "2007" "volumen" => "49" "paginaInicial" => "1490" "paginaFinal" => "1495" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17397680" "web" => "Medline" ] ] ] ] ] ] ] ] 20 => array:3 [ "identificador" => "bib0105" "etiqueta" => "21" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Cardioembolic stroke in aatrial fibrillation – rationale for preventive closure of the left atrial appendage" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "B. Leithäuser" 1 => "J.W. Park" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.4070/kcj.2009.39.11.443" "Revista" => array:6 [ "tituloSerie" => "Korean Circ J" "fecha" => "2009" "volumen" => "39" "paginaInicial" => "443" "paginaFinal" => "458" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19997539" "web" => "Medline" ] ] ] ] ] ] ] ] 21 => array:3 [ "identificador" => "bib0110" "etiqueta" => "22" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Success of surgical left atrial appendage closure – assessment by transesophageal echocardiography" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "A.S. Kanderian" 1 => "A.M. Gillinov" 2 => "G.B. Petterson" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jacc.2008.03.067" "Revista" => array:6 [ "tituloSerie" => "J Am Coll Cardiol" "fecha" => "2008" "volumen" => "52" "paginaInicial" => "924" "paginaFinal" => "929" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18772063" "web" => "Medline" ] ] ] ] ] ] ] ] 22 => array:3 [ "identificador" => "bib0115" "etiqueta" => "23" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Left Atrial Appemdage Occlusion Study (LAAOS): results of a randomized controlled pilot study of left atrial appendage occlusion during coronary bypass surgery in patients at risk for stroke" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "J.S. Healey" 1 => "E. Crystal" 2 => "A. Lamy" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.ahj.2004.09.054" "Revista" => array:6 [ "tituloSerie" => "Am Heart J" "fecha" => "2005" "volumen" => "150" "paginaInicial" => "288" "paginaFinal" => "293" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16086933" "web" => "Medline" ] ] ] ] ] ] ] ] 23 => array:3 [ "identificador" => "bib0120" "etiqueta" => "24" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "Thoracoscopic epicardial radiofrequency ablation for atrial fibrillation. NICE interventional procedures guidance 286. Available from: <a class="elsevierStyleInterRef" href="http://www.nice.org.uk/IPG286">www.nice.org.uk/IPG286</a> [accessed 15.06.10]" ] ] ] 24 => array:3 [ "identificador" => "bib0125" "etiqueta" => "25" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "ACC/AHA 2006 guidelines for the management of patients with valvular heart disease: executive summary" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "R.O. Bonow" 1 => "B.A. Carabello" 2 => "K. Chatterjee" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Circulation" "fecha" => "2006" "volumen" => "114" "paginaInicial" => "450" "paginaFinal" => "527" ] ] ] ] ] ] 25 => array:3 [ "identificador" => "bib0130" "etiqueta" => "26" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Feasibility of closed-chest ligation of the left atrial appendage in humans" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "K. Bartus" 1 => "J. Bednarek" 2 => "J. Myc" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.hrthm.2010.10.040" "Revista" => array:6 [ "tituloSerie" => "Heart Rhythm" "fecha" => "2011" "volumen" => "8" "paginaInicial" => "188" "paginaFinal" => "193" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21050893" "web" => "Medline" ] ] ] ] ] ] ] ] 26 => array:3 [ "identificador" => "bib0135" "etiqueta" => "27" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Percutaneous left atrial appendage transcatheter occlusion to prevent stroke in high-risk patients with atrial fibrillation: early clinical experience" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "H. Sievert" 1 => "M.D. Lesh" 2 => "T. Trepels" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Circulation" "fecha" => "2002" "volumen" => "105" "paginaInicial" => "1887" "paginaFinal" => "1889" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11997272" "web" => "Medline" ] ] ] ] ] ] ] ] 27 => array:3 [ "identificador" => "bib0140" "etiqueta" => "28" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Percutaneous left atrial appendage transcatheter occlusion (PLAATO system) to prevent stroke in high-risk patients with non-rheumatic atrial fibrillation: results from the international multi-center feasibility trials" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "S.H. Ostermayer" 1 => "M. Reisman" 2 => "P.H. Kramer" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jacc.2005.03.042" "Revista" => array:6 [ "tituloSerie" => "J Am Coll Cardiol" "fecha" => "2005" "volumen" => "46" "paginaInicial" => "9" "paginaFinal" => "14" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15992628" "web" => "Medline" ] ] ] ] ] ] ] ] 28 => array:3 [ "identificador" => "bib0145" "etiqueta" => "29" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Percutaneous left atrial appendage transcatheter occlusion (PLAATO) for stroke prevention in atrial fibrillation: 2-year outcomes" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "J.W. Park" 1 => "B. Leithäuser" 2 => "U. Gerk" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "J Invasive Cardiol" "fecha" => "2009" "volumen" => "21" "paginaInicial" => "446" "paginaFinal" => "450" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19726815" "web" => "Medline" ] ] ] ] ] ] ] ] 29 => array:3 [ "identificador" => "bib0150" "etiqueta" => "30" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Percutaneous left atrial appendage occlusion for patients with atrial fibrillation suboptimal for warfarin therapy: 5-year results of the PLAATO (Percutaneous Left Atrial Appendage Transcatheter Occlusion) study" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "P.C. Block" 1 => "S. Burstein" 2 => "P.N. Casale" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jcin.2009.05.005" "Revista" => array:6 [ "tituloSerie" => "JACC Cardiovasc Interv" "fecha" => "2009" "volumen" => "2" "paginaInicial" => "594" "paginaFinal" => "600" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19628179" "web" => "Medline" ] ] ] ] ] ] ] ] 30 => array:3 [ "identificador" => "bib0155" "etiqueta" => "31" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Transcatheter left atrial appendage occlusion with Amplatzer devices to obviate anticoagulation in patients with atrial fibrillation" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "B. Meier" 1 => "I. Palacios" 2 => "S. Windecker" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1002/ccd.10660" "Revista" => array:6 [ "tituloSerie" => "Catheter Cardiovasc Interv" "fecha" => "2003" "volumen" => "60" "paginaInicial" => "417" "paginaFinal" => "422" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/14571497" "web" => "Medline" ] ] ] ] ] ] ] ] 31 => array:3 [ "identificador" => "bib0160" "etiqueta" => "32" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Left atrial appendage closure with Amplatzer cardiac plug in atrial fibrillation: initial European experience" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "J.W. Park" 1 => "A. Bethencourt" 2 => "H. Sievert" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1002/ccd.22764" "Revista" => array:6 [ "tituloSerie" => "Catheter Cardiovasc Interv" "fecha" => "2011" "volumen" => "77" "paginaInicial" => "700" "paginaFinal" => "706" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20824765" "web" => "Medline" ] ] ] ] ] ] ] ] 32 => array:3 [ "identificador" => "bib0165" "etiqueta" => "33" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Thrombus formation after left atrial appendage exclusion using an Amplatzer cardiac plug device" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "I. Cruz-Gonzalez" 1 => "J. Martín Moreiras" 2 => "E. García" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1002/ccd.23126" "Revista" => array:6 [ "tituloSerie" => "Catheter Cardiovasc Interv" "fecha" => "2011" "volumen" => "78" "paginaInicial" => "970" "paginaFinal" => "973" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21523900" "web" => "Medline" ] ] ] ] ] ] ] ] 33 => array:3 [ "identificador" => "bib0170" "etiqueta" => "34" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Thrombus formation on a left atrial appendage closure device" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "L. Cardona" 1 => "G. Ana" 2 => "B. Luísa" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1161/CIRCULATIONAHA.110.004135" "Revista" => array:6 [ "tituloSerie" => "Circulation" "fecha" => "2011" "volumen" => "124" "paginaInicial" => "1595" "paginaFinal" => "1596" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21969319" "web" => "Medline" ] ] ] ] ] ] ] ] 34 => array:3 [ "identificador" => "bib0175" "etiqueta" => "35" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "Available from: <a class="elsevierStyleInterRef" href="http://www.mhra.gov.uk/home/groups/fsn/documents/fieldsafetynotice/con108673.pdf">www.mhra.gov.uk/home/groups/fsn/documents/fieldsafetynotice/con108673.pdf</a> [accessed 21.02.12]" ] ] ] 35 => array:3 [ "identificador" => "bib0180" "etiqueta" => "36" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Thrombus formation on the new amplatzer cardiac plug after LAA olccusion – a word of caution" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "B. Plicht" 1 => "P. Kahlert" 2 => "H. Kälsch" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:3 [ "tituloSerie" => "Clin Res Cardiol" "fecha" => "2011" "volumen" => "100" ] ] ] ] ] ] 36 => array:3 [ "identificador" => "bib0185" "etiqueta" => "37" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Left atrial appendage closure with the Amplatzer cardiac plug in patients with atrial fibrillation" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "E.E. Guérios" 1 => "M. Schmid" 2 => "S. Gloekler" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Arq Bras Cardiol" "fecha" => "2012" "volumen" => "98" "paginaInicial" => "528" "paginaFinal" => "536" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22584492" "web" => "Medline" ] ] ] ] ] ] ] ] 37 => array:3 [ "identificador" => "bib0190" "etiqueta" => "38" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "Amplatzer Cardiac Plug Clinical Trial (ACP). Available from: <a class="elsevierStyleInterRef" href="http://www.clinicaltrials.gov/">www.clinicaltrials.gov/identiﬁcador: NCT01118299</a> [accessed 21.02.12]" ] ] ] 38 => array:3 [ "identificador" => "bib0195" "etiqueta" => "39" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Safety of percutaneous left atrial appendage closure: results from the Watchman left atrial appendage system for embolic protection in patients with AF (PROTECT AF) clinical trial and the continued access registry" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "V.Y. Reddy" 1 => "D. Holmes" 2 => "S.K. Doshi" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1161/CIRCULATIONAHA.110.976449" "Revista" => array:6 [ "tituloSerie" => "Circulation" "fecha" => "2011" "volumen" => "123" "paginaInicial" => "417" "paginaFinal" => "424" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21242484" "web" => "Medline" ] ] ] ] ] ] ] ] 39 => array:3 [ "identificador" => "bib0200" "etiqueta" => "40" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "ASA Plavix feasibility study with WATCHMAN left atrial appendage closure technology. Available from: <a class="elsevierStyleInterRef" href="http://www.clinicaltrials.gov/">www.clinicaltrials.gov/identificador: NCT00851578</a>" ] ] ] 40 => array:3 [ "identificador" => "bib0205" "etiqueta" => "41" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "First formal analysis of the ASA Plavix Registry (ASAP): Watchman left atrial appendage closure in atrial fibrillation patients with contraindication to oral anticoagulation" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "V. Reddy" 1 => "P. Neuzil" 2 => "M.A. Miller" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "LibroEditado" => array:3 [ "titulo" => "Heart Rhythm Society 2012 Scientific Sessions" "conferencia" => "Boston, MA, May 11" "serieFecha" => "2012" ] ] ] ] ] ] 41 => array:3 [ "identificador" => "bib0210" "etiqueta" => "42" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The clinical impact of incomplete left atrial appendage closure with the Watchman device in patients with atrial fibrillation: A PROTECT-AF (percutaneous closure of the left atrial appendage versus warfarin therapy for prevention of stroke in patients with atrial fibrillation) substudy" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "J.F. Viles-Gonzalez" 1 => "S. Kar" 2 => "P. 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Review article

Percutaneous closure of the left atrial appendage for thromboembolic prevention in atrial fibrillation

Encerramento percutâneo do apêndice auricular esquerdo para profilaxia de tromboembolismo na fibrilhação auricular

Ana Faustino

Corresponding author

anacatarina.faustino@gmail.com

Corresponding author.

, Luís Paiva, Rui Providência, Romeu Cação, Marco Costa, António Leitão-Marques

Serviço de Cardiologia, Centro Hospitalar e Universitário de Coimbra – Centro Hospitalar de Coimbra, Coimbra, Portugal

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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Atrial fibrillation &#40;AF&#41; is a common arrhythmia with high morbidity and mortality due to its thromboembolic potential&#46; Warfarin has been the first-line therapy for thromboembolic prevention&#44; but it has various contraindications and limitations&#46; Thrombi in AF form mainly in the left atrial appendage &#40;LAA&#41;&#44; and so closure of the LAA is considered an alternative to warfarin therapy&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Prevalence of atrial fibrillation</span><p id="par0010" class="elsevierStylePara elsevierViewall">AF is the most common cardiac arrhythmia in clinical practice&#46; Its prevalence in Portugal is 2&#46;5&#37; in those aged 40 or over according to the FAMA study&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> The figure in the general population is 1&#8211;2&#37;&#44; rising with age&#59; prevalence has increased significantly over time and is predicted to double in the next 50 years&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">The importance of thromboembolism in atrial fibrillation</span><p id="par0015" class="elsevierStylePara elsevierViewall">The risk of stroke is five times higher in those with AF than in those in sinus rhythm&#46;<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2&#44;3</span></a> The large size of the thrombi that cause these strokes means that their consequences tend to be more severe than from other sources of cerebral thrombi&#46;<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2&#44;4&#8211;6</span></a></p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Chronic anticoagulation with warfarin</span><p id="par0020" class="elsevierStylePara elsevierViewall">Oral anticoagulation with warfarin remains the first-line therapy to prevent thromboembolic events in AF&#46; It is indicated in all patients with CHADS<span class="elsevierStyleInf">2</span> or CHA<span class="elsevierStyleInf">2</span>DS<span class="elsevierStyleInf">2</span>-VASC score &#8805;2&#44; and should also be considered with a score of 1&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> Its efficacy has been demonstrated in numerous randomized clinical trials&#44; which have shown that with a target international normalized ratio &#40;INR&#41; of 2&#8211;3&#44; relative risk for stroke is reduced by 60&#8211;73&#37;&#46;<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2&#44;4&#8211;9</span></a> Its superiority over aspirin &#40;reduction of 20&#37;<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2&#44;7</span></a>&#41;&#44; combined aspirin and clopidogrel&#44; and a single antiplatelet drug plus low-dose warfarin&#44;<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2&#44;10&#44;11</span></a> is well established&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">However&#44; warfarin is contraindicated in 14&#8211;44&#37; of patients at risk of stroke&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a> Even among eligible patients&#44; only 54&#37; are anticoagulated&#44; for a variety of reasons&#44; the most important being bleeding risk&#59; others include a narrow therapeutic window and the sensitivity of its pharmacokinetics to a range of foods and other drugs&#44; which necessitate frequent laboratory testing and the patient&#39;s cooperation&#46; The risk of trauma&#44; access to INR monitoring&#44; clinicians&#8217; wariness&#44; and patient preferences can also make warfarin therapy impractical&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> Anticoagulation is thus often inadequate&#44; and INR values are within the therapeutic window in only 50&#8211;68&#37; of tests&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a></p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">New oral anticoagulants</span><p id="par0030" class="elsevierStylePara elsevierViewall">New anticoagulants have been developed as alternatives to warfarin for thromboembolic prevention in AF&#46; There are two main classes&#58; direct thrombin inhibitors such as dabigatran&#44; and factor Xa inhibitors such as rivaroxaban&#44; apixaban&#44; edoxaban and betrixaban&#46; They all have advantages over warfarin including a wider therapeutic window&#44; fewer interactions with foods&#44; and no need for laboratory monitoring&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> Only dabigatran &#40;the RE-LY study<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a>&#41;&#44; rivaroxaban &#40;ROCKET-AF<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a>&#41; and apixaban &#40;ARISTOTLE<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a>&#41; have demonstrated non-inferiority to warfarin in thromboembolic prevention in AF&#44; and only the first two have been approved by the US Food and Drug Administration &#40;FDA&#41; for this purpose&#46;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">16</span></a> The latest guidelines for the management of atrial fibrillation of the European Society of Cardiology consider dabigatran an alternative in patients at high embolic risk if warfarin is contraindicated or impractical&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> The latest Canadian Cardiovascular Society guidelines also recommend the use of dabigatran rather than warfarin in AF patients with indication for oral anticoagulation&#46;<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">17</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">However&#44; these drugs are expensive for chronic therapy&#44; carry a significant risk of bleeding&#44; and do not have an established antidote&#44; all which are obstacles to their use in many patients&#46; Studies on these new anticoagulants have also shown significant rates of discontinuation of therapy&#44; mainly due to intolerance or adverse effects&#44; reaching 25&#46;3&#37; in patients taking apixaban &#40;vs&#46; 27&#46;5&#37; for those taking warfarin&#41; in the ARISTOTLE trial&#44;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a> but higher than seen for warfarin in the RE-LY<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a> &#40;21&#37; for dabigatran vs&#46; 17&#37;&#41; and ROCKET-AF<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a> &#40;23&#46;7&#37; for rivaroxaban vs&#46; 22&#46;2&#37;&#41; trials&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">The importance of the left atrial appendage in thromboembolism</span><p id="par0040" class="elsevierStylePara elsevierViewall">The LAA is an embryonic remnant of the left atrium &#40;LA&#41; consisting of a long tubular body with walls as little as 1<span class="elsevierStyleHsp" style=""></span>mm thick&#44; usually multilobulated and trabeculated&#44; that communicates with the LA through an oval orifice&#46;<a class="elsevierStyleCrossRefs" href="#bib0090"><span class="elsevierStyleSup">18&#44;19</span></a> It is generally thought to have a role in regulating body volume via physiological mechanisms that include the production of 30&#37; of atrial natriuretic peptide&#44; regulation of thirst&#44; and modulation of the volume&#47;pressure ratio and LA compliance&#44; and hence cardiac output&#46;<a class="elsevierStyleCrossRefs" href="#bib0100"><span class="elsevierStyleSup">20&#8211;22</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">The LAA is also the most common site of intracardiac thrombi in AF &#40;98&#37;&#41;&#44; as demonstrated in autopsy studies&#44; by transesophageal echocardiography &#40;TEE&#41; and by direct intraoperative inspection&#46;<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">11&#44;12&#44;18&#44;19</span></a> It is more frequently the site of thrombi in non-valvular &#40;90&#37;&#41; than valvular AF &#40;57&#37;&#41;&#44;<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">12&#44;18&#44;19</span></a> and in patients with previous ischemic stroke&#46;<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">20</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">In the light of these facts&#44; exclusion of the LAA from the circulation was seen as an alternative to pharmacological anticoagulation to prevent thromboembolism in AF&#46; Different methods have been developed&#44; some more invasive than others&#46;<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">12&#44;13</span></a></p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Surgical exclusion of the LAA</span><p id="par0055" class="elsevierStylePara elsevierViewall">The first attempt to surgically exclude the LAA&#44; during mitral valve surgery&#44; was described in the 1930s&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> The LAAOS study&#44; the first randomized trial of surgical LAA occlusion&#44; in patients referred for coronary bypass surgery at risk for AF or ischemic stroke&#44; concluded that surgical exclusion of the LAA was safe and did not increase operative time or perioperative bleeding&#46;<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">23</span></a></p><p id="par0060" class="elsevierStylePara elsevierViewall">Surgical exclusion began to be performed in various centers&#44; but it was then discovered that exclusion was often incomplete&#44; and success rates varied widely &#40;10&#46;3&#8211;60&#37;<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">22</span></a>&#41; due to differences in surgical techniques&#44; surgical expertise&#44; and criteria for success&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">Kanderian et al&#46;<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">22</span></a> retrospectively analyzed TEEs performed after surgical LAA closure&#44; which was not at that time a routine procedure&#44; and found a higher failure rate than those seen in small series&#44; in which the criteria for occlusion were less rigorous&#46; The authors concluded that excision was the most effective technique and that incomplete closure increased the likelihood of blood pooling and thrombus formation&#59; they recommended that anticoagulation should be continued until confirmation of complete occlusion by TEE&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">Open surgery for LAA closure via an epicardial approach has also been performed using the AtriCure system &#40;AtriClip&#44; Cincinnati&#44; OH&#41; in AF patients undergoing coronary bypass surgery or valve replacement&#59; the three-month success rate was 100&#37;&#46;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a> A thoracoscopic epicardial approach was used for LAA occlusion in 15 patients for thromboembolic prevention&#44; and in many other small series during AF ablation&#46;<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">24</span></a> However&#44; this approach was associated with additional complications including pneumothorax and need for conversion to open surgery due to bleeding&#44; adherences&#44; or other problems&#46;<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">24</span></a></p><p id="par0075" class="elsevierStylePara elsevierViewall">The invasive nature of surgical LAA occlusion means that it has only been performed during cardiac surgery for another reason&#46; It is used as part of the MAZE procedure<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5&#44;22</span></a> and is recommended in the ACC&#47;AHA guidelines on valvular heart disease during mitral valve surgery&#46;<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">25</span></a></p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Minimally invasive LAA exclusion</span><p id="par0080" class="elsevierStylePara elsevierViewall">The invasive nature of surgical LAA exclusion has prompted the development of closure devices using minimally invasive methods&#44; including techniques combining epicardial and endocardial approaches&#46; One example is the LARIAT<span class="elsevierStyleSup">&#174;</span> system &#40;SentreHEART&#44; Palo Alto&#44; CA&#41;&#44; approved by the FDA&#44; which combines epicardial delivery of a snare with a pre-tied suture via a small-caliber catheter and a balloon catheter introduced endocardially using a magnet-tipped guidewire to position the suture around the base of the LAA&#46; The system was assessed in AF patients undergoing mitral valve surgery &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>2&#41; or AF ablation &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>11&#41;&#44; and its feasibility was demonstrated&#46;<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">26</span></a></p><p id="par0085" class="elsevierStylePara elsevierViewall">Percutaneous LAA closure techniques have also been developed that use an exclusively endocardial approach&#46;</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Endocardial percutaneous LAA closure</span><p id="par0090" class="elsevierStylePara elsevierViewall">Percutaneous LAA closure using an endocardial approach is based on delivery of the device via a percutaneous catheter introduced through a femoral vein that reaches the LAA via septal puncture&#46; Implantation is guided by fluoroscopy and&#47;or TEE&#46; An intravenous heparin bolus is administered to achieve partial activated thromboplastin time of &#8805;250 s&#46;<a class="elsevierStyleCrossRefs" href="#bib0100"><span class="elsevierStyleSup">20&#44;27&#44;28</span></a></p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">The PLAATO device</span><p id="par0095" class="elsevierStylePara elsevierViewall">The first percutaneous LAA closure device was the PLAATO &#40;Percutaneous Left Atrial Appendage Transcatheter Occlusion&#41; system &#40;ev3 Inc&#46;&#44; Plymouth&#44; MN&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">27</span></a> It consisted of a self-expanding nitinol cage coated with a polytetrafluoroethylene membrane designed both to occlude LAA flow and to allow tissue incorporation into the device&#46; There were also three rows of anchors to attach the device to the LAA orifice &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">27</span></a></p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0100" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a> lists data on the main clinical trials on the PLAATO device&#46; The first clinical trial in Europe&#44; by Sievert et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">27</span></a> included 15 patients with chronic non-rheumatic AF&#44; high risk for thromboembolism on CHADS<span class="elsevierStyleInf">2</span> criteria or with spontaneous echo contrast in the LAA and contraindications to warfarin&#46; Device implantation was successful in all patients&#44; with no residual shunt&#44; new thrombus formation on the device&#44; device migration or thromboembolic phenomena at one-month follow-up&#46; The only complication was one case of pericardial effusion resolved by pericardiocentesis&#46;<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">27</span></a></p><p id="par0105" class="elsevierStylePara elsevierViewall">This was followed by an international multicenter prospective trial by Ostermayer et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">28</span></a> which included results from five centers in Europe and North America and was the largest study on the PLAATO device&#46; The study population consisted of patients with non-rheumatic AF of at least three months&#8217; duration&#44; contraindication to warfarin and high risk for thromboembolic events &#40;history of myocardial infarction or significant coronary stenosis&#44; CHADS<span class="elsevierStyleInf">2</span> criteria or moderate or dense spontaneous contrast or blood flow velocity &#8804;20<span class="elsevierStyleHsp" style=""></span>cm&#47;s within the LAA on echocardiography&#41;&#46; It was the first study to use angiographic grading to evaluate LAA occlusion &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#44; which was also assessed by transesophageal color Doppler echocardiography and graded on a five-point scale &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0110" class="elsevierStylePara elsevierViewall">Occlusion was successful in 97&#46;3&#37; of cases &#40;108&#47;111&#41;&#46; During a mean follow-up of 10 months&#44; the stroke rate was 2&#46;2&#37;&#59; these two events occurred 6&#8211;7 months after the implant procedure&#44; and in both cases the device was in stable position with no significant leak or adhering thrombi&#46; The authors calculate that this rate was one-third of that predicted on the basis of the patients&#8217; mean CHADS<span class="elsevierStyleInf">2</span> score of 2&#46;5 points &#40;estimated annual stroke rate of 6&#46;3&#37;&#41;&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">Five patients among the first to undergo the technique experienced pericardial effusion&#44; which was attributed to lack of experience with the technique&#46; One required surgery and died from postoperative complications&#46; There were no other significant complications and no instances of device dislocation or migration &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">28</span></a></p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0120" class="elsevierStylePara elsevierViewall">The largest series of patients treated with the PLAATO device&#44; reported by Park et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">29</span></a> was in a single German center&#46; Percutaneous LAA closure was performed in 71 patients with rheumatic and non-rheumatic AF&#44; most chronic but paroxysmal in eight cases&#44; with contraindication to oral anticoagulation or history of stroke under anticoagulant therapy&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">Occlusion was successful in 97&#46;3&#37; of patients&#46; In a mean follow-up of 24 months&#44; one minor stroke was reported &#40;1&#46;4&#37;&#41;&#44; a lower rate than the 5&#37; predicted on the basis of a mean CHADS<span class="elsevierStyleInf">2</span> score of 2&#46;5&#46; One device embolization occurred&#44; occluding the left ventricular outflow tract&#44; resulting in the patient&#39;s death&#44; and there was one case of device instability requiring removal by open surgery&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">Ten deaths &#40;7&#37;&#41; occurred during follow-up&#44; but only one &#40;described above&#41; was procedure-related&#46; There was one case of pericardial effusion&#44; which resolved without pericardiocentesis &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">29</span></a></p><p id="par0135" class="elsevierStylePara elsevierViewall">A prospective non-randomized multicenter clinical trial in North America&#44; that of Block et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">30</span></a> analyzed 64 patients with non-valvular FA &#40;chronic or paroxysmal&#41; not eligible for chronic warfarin therapy and with CHADS<span class="elsevierStyleInf">2</span> score of &#8805;2&#46; The procedure was successful in 93&#46;8&#37; of patients&#59; mean follow-up was 3&#46;75 years&#44; and up to five years in some cases&#46; The stroke rate was 3&#46;8&#37;&#58; five major &#40;between 7 and 53 months after the procedure&#41; and three minor &#40;8&#8211;23 months&#41;&#46; There was one transient ischemic attack &#40;TIA&#41;&#46; The total stroke&#47;TIA rate of 3&#46;8&#37; was little more than half that predicted by the mean CHADS<span class="elsevierStyleInf">2</span> score of 2&#46;6 &#40;6&#46;6&#37;&#41;&#46;</p><p id="par0140" class="elsevierStylePara elsevierViewall">There were two deaths&#44; one from cerebral hemorrhage and the other from surgical complications unrelated to the device or the closure technique&#46; The only procedure-related complication was a pericardial effusion requiring surgery &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">30</span></a></p><p id="par0145" class="elsevierStylePara elsevierViewall">Other smaller series have been published from different centers&#44; all of them confirming the efficacy of the PLAATO device for preventing stroke in AF&#46; However&#44; the device was eventually withdrawn from the market by the manufacturer&#46;</p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Amplatzer devices</span><p id="par0150" class="elsevierStylePara elsevierViewall">The second device to be used for percutaneous LAA closure was the Amplatzer septal occluder &#40;St&#46; Jude Medical&#44; Plymouth&#44; MN&#41;&#44; which was originally used to close atrial septal defects &#40;ASD&#41;&#46; It was tested in 16 patients in four centers in 2002 by Meier et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">31</span></a> who reported a single complication&#44; embolization of an inappropriately sized device&#46; The septal occluder was not used again for this purpose&#59; instead&#44; a device was developed specifically for LAA closure&#44; the Amplatzer Cardiac Plug &#40;ACP&#41; &#40;St&#46; Jude Medical&#44; Plymouth&#44; MN&#41;&#44;<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">32</span></a> with a self-expanding nitilol frame covered in a polyester patch&#44; consisting of a lobe and a disc connected by a central waist&#46; Hooks on the lobe fix the device&#44; while the disc seals the LAA orifice &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Figure 2</a>&#41;&#46; It is available in eight lobe sizes from 16 to 30 mm at 2-mm intervals&#46;<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">32</span></a></p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0155" class="elsevierStylePara elsevierViewall">As the ACP began to be widely used&#44; and in the light of safety concerns&#44; Park et al&#46;<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">32</span></a> reviewed the experience of various centers to assess its safety profile&#44; retrospectively analyzing implantations from its first use in December 2008 to November 2009&#44; in a total of 143 AF patients in 10 European centers&#46; Warfarin was suspended in all cases before ACP implantation&#44; while dual antiplatelet therapy was maintained for 1&#8211;3 months&#44; followed by single antiplatelet therapy indefinitely &#40;<a class="elsevierStyleCrossRef" href="#tbl0020">Table 4</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0020"></elsevierMultimedia><p id="par0160" class="elsevierStylePara elsevierViewall">The registry did not aim to assess indications for LAA closure or the effectiveness of the procedure&#44; but to analyze the feasibility and safety of the ACP 24 hours after implantation&#46; This was successful in 96&#37; of patients&#59; in the remainder implantation was unsuccessful due to device embolization &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>2&#41; or unfavorable anatomy &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>3&#41;&#46; The device needed replacing in 17&#37; of cases&#46;</p><p id="par0165" class="elsevierStylePara elsevierViewall">Serious complications were seen in 10 patients &#40;7&#37;&#41;&#58; three with stroke due to air embolism or intracardiac thrombus&#59; device embolization in two cases&#44; both percutaneously recaptured&#44; with no sequelae&#59; and five with pericardial effusion requiring pericardiocentesis&#46; Minor complications were insignificant pericardial effusions in four&#44; transient myocardial ischemia due to air embolism in two&#44; and loss of the implant in the venous system in one patient&#44; recovered percutaneously &#40;<a class="elsevierStyleCrossRef" href="#tbl0020">Table 4</a>&#41;&#46;</p><p id="par0170" class="elsevierStylePara elsevierViewall">The authors concluded that the ACP could be successfully implanted in a slightly higher proportion of patients than in the PROTECT AF trial&#44;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> with a similar adverse event rate&#46; They also stressed the importance of the learning curve in reducing procedure-related complications&#46; The ability of the LAA to adapt to pressure was given as the main reason for incorrect device sizing&#44; but the authors also pointed out that the ACP is a more flexible device and thus better able to adapt to the oval shape of the LAA orifice&#46; One cause they identified for pericardial effusion was perforation of the LAA&#44; due to its thin walls&#59; as causes of periprocedural stroke&#44; they reported air embolism and small LAA thrombi located in fully contracted lobes that were not visualized on TEE&#44; and suggest these could be detected by multiple contrast injections&#46; The periprocedural stroke rate was 2&#37;&#46;<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">32</span></a></p><p id="par0175" class="elsevierStylePara elsevierViewall">This registry made no mention of formation of thrombi on the ACP&#44; but reports subsequently appeared of thrombi adhering to the device&#46; In one case&#44; a patient with chronic AF&#44; CHADS<span class="elsevierStyleInf">2</span> score of 2 and contraindication to oral anticoagulation&#44; underwent successful percutaneous LAA exclusion and was prescribed clopidogrel for one month and aspirin indefinitely&#44; but TEE at three-month follow-up revealed a thrombus adhering to the device&#44; which was resolved by enoxaparin 60<span class="elsevierStyleHsp" style=""></span>mg twice daily and aspirin&#44; continued thereafter&#46;<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">33</span></a> In another case&#44; percutaneous LAA closure with the ACP was successfully performed in a patient with chronic AF&#44; CHADS<span class="elsevierStyleInf">2</span> score of 6 and contraindication to oral anticoagulation due to chronic hematuria&#44; who was prescribed clopidogrel and aspirin&#46; Six-month follow-up TEE detected a thrombus on the device&#44; treated by intravenous heparin&#44; which took three weeks to have any effect in reducing the thrombus&#46; Oral anticoagulation was accordingly started but had to be discontinued due to hematuria&#59; no thromboembolic events were recorded&#46;<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">34</span></a></p><p id="par0180" class="elsevierStylePara elsevierViewall">In view of increasing concerns over this complication&#44; in January 2011 the manufacturer &#40;at that time AGA Medical&#41;&#44; after investigating these cases&#44; published a Field Safety Notice for all centers implanting the ACP&#44; updating the instructions for use&#44; stating that the most likely cause for thrombus formation on the device was excessively deep implantation&#44; and emphasizing the importance of measuring the depth of the LAA and width of the orifice at the implantation site&#46; It also claims that adequacy of the anticoagulation and&#47;or antiplatelet regimen can also be considered a potential contributor in thrombus formation&#44; recommending aspirin for six months post-implant&#44; leaving the decision to continue this regimen after six months at the discretion of the physician&#44; and recommending clopidogrel or an alternate antiplatelet&#44; with prescription following routine standard of care&#46;<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">35</span></a></p><p id="par0185" class="elsevierStylePara elsevierViewall">In April 2011 Plicht et al&#46; published a series assessing thrombus formation on the ACP in 31 patients&#44; all of whom were medicated after implantation in accordance with the manufacturer&#39;s instructions&#46; They underwent TEE before discharge and at three and six months&#59; device thrombus was detected in three patients on the pre-discharge TEE and in three more at three months&#46; In three of these patients the thrombi resolved after intravenous heparin administration for one week and oral anticoagulation was reinitiated for another three months in the other three&#44; and one patient still had thrombus at the time of publication&#46; The authors found no significant difference in the implantation site between those with and those without thrombi&#44; and considered that thrombus formation in their series did not appear to be related to deep device implantation&#46;<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">36</span></a></p><p id="par0190" class="elsevierStylePara elsevierViewall">The experience of a single Swiss center was published in May 2012 by Gu&#233;rios et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">37</span></a> assessing the safety and efficacy of the ACP in patients with non-valvular AF &#40;chronic or paroxysmal&#41; with at least one additional risk factor for thromboembolism and contradiction or intolerance to chronic oral anticoagulation&#46; The procedure was guided by angiography alone&#46; Patients were prescribed clopidogrel for one month and aspirin for 3&#8211;4 months&#44; or lifelong if there was significant coronary artery disease&#46; TEE was performed before discharge and 3&#8211;6 months after implantation&#46; Procedural success was obtained in 85 of the 86 treated patients &#40;99&#37;&#41;&#46; The unsuccessful case was attributed to a patent foramen ovale &#40;PFO&#41; previously closed with an Amplatzer septal occluder&#59; repeated attempts at implantation resulted in pericardial tamponade&#44; resolved by pericardial drainage&#46; Eighty-seven devices were implanted in the other 85 patients&#59; in 81 of them success was achieved with the first device chosen&#44; while in four the device had to be changed&#46; In two patients LAA closure was incomplete&#59; in one of them&#44; an additional ACP was used&#44; and an Amplatzer vascular plug in the other&#44; with good final results&#46;</p><p id="par0195" class="elsevierStylePara elsevierViewall">In 48 patients &#40;55&#46;8&#37;&#41; LAA closure was combined with another intervention&#44; such as ASD closure&#44; percutaneous coronary intervention&#44; or transcatheter aortic valve implantation&#46;</p><p id="par0200" class="elsevierStylePara elsevierViewall">One ACP embolization occurred about 15 minutes after being released during percutaneous coronary angioplasty&#59; the device was retrieved and replaced by a smaller ACP&#46; During the procedure&#44; there was a pericardial effusion in one patient with no hemodynamic compromise&#44; two ischemic cerebral events&#44; one due to air embolism and the other probably thromboembolic&#44; and one death six days after implantation due to bleeding from a gastrointestinal tumor&#46; Follow-up was obtained in 69 of the remaining patients &#40;a total of 25&#46;9 patient-years&#41;&#44; during which there were two deaths&#44; one non-cardiovascular &#40;bronchopneumonia&#41; and the other cardiovascular&#44; in a patient with three-vessel coronary disease&#46; No other embolic events or peri-device leaks were observed&#44; but a non-mobile thrombus was detected in six patients&#44; which disappeared after oral anticoagulation for three months&#46; In four patients&#44; the presence of a fixed thrombus could not be ruled out&#59; in one warfarin was prescribed for four months&#44; no change being observed in the control TEE&#44; and the other three remained on aspirin&#46; After reviewing the results&#44; the authors concluded that in 70&#37; of cases with thrombi the device had been implanted more deeply than was desirable&#46;</p><p id="par0205" class="elsevierStylePara elsevierViewall">The prospective randomized Amplatzer Cardiac Plug Clinical Trial is currently under way&#44; comparing the efficacy of the ACP with warfarin in patients with AF and CHADS<span class="elsevierStyleInf">2</span> score &#8805;2&#44; and without contraindication for oral coagulation&#46;<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">38</span></a></p></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">The Watchman left atrial appendage system</span><p id="par0210" class="elsevierStylePara elsevierViewall">The Watchman device &#40;Boston Scientific&#44; Plymouth&#44; MN&#41; was designed specifically for percutaneous LAA closure&#46; It consists of a self-expanding nitinol frame with fixation barbs around its perimeter and a porous polyester membrane only on the LA-facing surface &#40;<a class="elsevierStyleCrossRef" href="#fig0015">Figure 3</a>&#41;&#46; It is available in diameters of 21&#44; 24&#44; 27&#44; 30 and 33<span class="elsevierStyleHsp" style=""></span>mm&#44; which should be 10&#8211;20&#37; greater than the LAA orifice&#46;<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">20</span></a></p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0215" class="elsevierStylePara elsevierViewall">The first clinical trial&#44; by Sick et al&#46;&#44; aimed to assess the feasibility of this device for LAA closure&#46;<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">20</span></a> It prospectively included 75 patients from centers in Europe and the US with a history of chronic or paroxysmal AF and CHADS<span class="elsevierStyleInf">2</span> score &#8805;1 without contradiction for oral anticoagulation&#46;</p><p id="par0220" class="elsevierStylePara elsevierViewall">Following the procedure patients were medicated with aspirin &#40;81&#8211;100<span class="elsevierStyleHsp" style=""></span>mg daily&#41;&#44; continued indefinitely&#44; and warfarin for 45 days&#46; Control TEE was performed at 45 days&#59; if the LAA was successfully sealed according to the criteria of absence of flow or minimal flow around the device &#40;jet of &#60;3<span class="elsevierStyleHsp" style=""></span>mm&#41;&#44; warfarin was discontinued&#46; The therapeutic regimen was later modified to include concomitant therapy with aspirin and 75<span class="elsevierStyleHsp" style=""></span>mg clopidogrel between 45 days and the six-month follow-up&#46;</p><p id="par0225" class="elsevierStylePara elsevierViewall">Closure was successful in 93&#37; of cases &#40;54 of 58&#41;&#46; The first 16 patients received a first-generation device&#44; which was associated with a significant number of complications including two device embolizations&#44; one air embolism leading to a malignant arrhythmia requiring cardiopulmonary resuscitation&#44; and one fractured delivery wire&#46; The delivery system was subsequently modified and the device was redesigned&#59; the second-generation device was used in 53 patients and no further embolizations occurred&#46; Pericardial effusions occurred in two of the 75 cases &#40;2&#46;6&#37;&#41; related to the transseptal puncture procedure&#44; one to an overly vigorous &#8220;tug test&#8221; usually performed for proof of stability of the device&#46; The technique was modified to observe the LAA during the tug&#44; either by fluoroscopy or TEE&#44; and no further tug-related effusions were observed&#46;</p><p id="par0230" class="elsevierStylePara elsevierViewall">No strokes occurred during the 24-month follow-up&#44; compared with the expected rate of 1&#46;9&#47;year based on the CHADS<span class="elsevierStyleInf">2</span> score in this study cohort&#46; Two cases of TIA occurred&#44; one at four months without visible device thrombus and the other at six months with a smooth layer of thrombus detected on the surface of the device&#46; Three more patients showed thrombus formation on the device surface without neurological symptoms&#46; The authors concluded that the endothelialization process may not be completed at 45 days after implantation when warfarin is discontinued&#44; so they modified the therapeutic regimen to include concomitant therapy with aspirin and clopidogrel between 45 days and the six-month follow-up&#46;</p><p id="par0235" class="elsevierStylePara elsevierViewall">There were three major bleeding complications&#44; two of which were pericardial effusions requiring pericardiocentesis&#44; and one internal bleed due to retrieval after device embolization&#46; There were minor bleeds in two patients&#46;</p><p id="par0240" class="elsevierStylePara elsevierViewall">Two patients died during follow-up&#58; one from dissection of the ascending aorta and the other from multiple organ failure after bowel surgery&#46;</p><p id="par0245" class="elsevierStylePara elsevierViewall">The authors considered the results comparable to those reported for the PLAATO system&#44; but with early results potentially biased by the use of a first-generation device and operator learning curves&#46;</p><p id="par0250" class="elsevierStylePara elsevierViewall">The PROTECT AF trial&#44;<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">8&#44;9</span></a> the first randomized clinical trial to directly compare percutaneous LAA closure &#40;with the Watchman device&#41; and warfarin&#44; ran from February 2007 to June 2008&#44; aiming to assess the non-inferiority of LAA closure in terms of efficacy and safety&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a></p><p id="par0255" class="elsevierStylePara elsevierViewall">The study population consisted of 707 patients in 59 centers in Europe and the US with non-valvular paroxysmal&#44; persistent or chronic AF&#44; CHADS<span class="elsevierStyleInf">2</span> score of &#8805;1 and without contraindication to warfarin&#46; They were randomly assigned in a 2&#58;1 ratio to device implantation &#40;463 patients&#59; intervention group&#41; or warfarin therapy &#40;244&#59; control group&#41;&#46; Mean follow-up was 18 months&#46;</p><p id="par0260" class="elsevierStylePara elsevierViewall">In the control group&#44; the target INR of 2&#46;0&#8211;3&#46;0 was assessed every two weeks in the first six months&#44; followed by monthly assessment&#46; INR remained within the therapeutic range in 66&#37; of measurements&#46; In the intervention group warfarin was continued for 45 days after implantation in order to promote endothelization of the device&#46; TEE was repeated at 45 days to verify successful closure &#40;defined as no peri-device flow or flow &#60;5<span class="elsevierStyleHsp" style=""></span>mm wide &#40;&#60;3<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2<span class="elsevierStyleHsp" style=""></span>mm&#41;&#46; If confirmed&#44; warfarin was replaced by dual antiplatelet therapy with clopidogrel 75<span class="elsevierStyleHsp" style=""></span>mg and aspirin 81&#8211;325<span class="elsevierStyleHsp" style=""></span>mg for six months&#44; followed by aspirin indefinitely&#46; Follow-up consultations were scheduled for 45 days&#44; six&#44; nine and 12 months&#44; and thenceforth twice a year&#46; Neurological assessment was performed initially&#44; at 12 and 24 months&#44; and whenever a neurological event occurred&#46;</p><p id="par0265" class="elsevierStylePara elsevierViewall">Implantation of the Watchman device was successful in 88&#37; of patients &#40;408&#47;463&#41; and in 91&#37; of those in whom it was attempted &#40;408&#47;449&#41;&#46; Warfarin was discontinued at 45 days in 86&#37; of patients and at six months in 92&#37;&#46;</p><p id="par0270" class="elsevierStylePara elsevierViewall">Efficacy was assessed by a composite endpoint of ischemic stroke&#44; hemorrhagic stroke&#44; cardiovascular or unexplained death and systemic embolism&#46; This occurred at a rate of 3&#37;&#47;year in the intervention group vs&#46; 4&#46;9&#37;&#47;year in the control group &#40;rate ratio 0&#46;62&#44; 95&#37; confidence interval 0&#46;35&#8211;1&#46;25&#41;&#44; and the probability of non-inferiority of the intervention was more than 99&#46;9&#37;&#46;</p><p id="par0275" class="elsevierStylePara elsevierViewall">The total number of strokes was higher in the control group&#44; but the rate of ischemic stroke was higher in the intervention group&#58; one before implantation&#44; five during &#40;due to air embolism&#41;&#44; and nine after&#46; Six ischemic strokes were observed in the control group&#46; INR assessed at the time of the stroke was subtherapeutic in both groups&#46;</p><p id="par0280" class="elsevierStylePara elsevierViewall">Hemorrhagic stroke was more common in the control group &#40;6&#41;&#59; five were fatal&#44; all of which occurred with therapeutic warfarin levels&#46; There was one hemorrhagic stroke under warfarin therapy in the intervention group&#46;</p><p id="par0285" class="elsevierStylePara elsevierViewall">There were 21 deaths in the intervention group &#40;4&#46;5&#37;&#41;&#44; due to stroke &#40;2&#59; 0&#46;4&#37;&#41;&#44; cardiovascular or unexplained &#40;4&#59; 0&#46;9&#37;&#41;&#44; and non-cardiovascular &#40;15&#59; 3&#46;2&#37;&#41;&#46; In the control group there were 18 deaths &#40;7&#46;4&#37;&#41;&#44; due to stroke &#40;6&#59; 2&#46;4&#37;&#41;&#44; cardiovascular or unexplained &#40;6&#59; 2&#46;4&#37;&#41;&#44; and non-cardiovascular &#40;6&#59; 2&#46;4&#37;&#41;&#46; Cumulative mortality in the intervention group and control group was 3&#37; vs&#46; 3&#46;1&#37; at one year and 5&#46;9&#37; vs&#46; 9&#46;1&#37; at two years&#44; respectively&#46;</p><p id="par0290" class="elsevierStylePara elsevierViewall">The safety composite endpoint was major bleeding &#40;requiring transfusion of at least two units of packed red blood cells or surgical intervention&#41; and procedure-related complications including stroke&#44; device embolization or severe pericardial effusion requiring percutaneous or surgical drainage&#46; These events were more frequent in the intervention group &#40;7&#46;4&#37;&#47;year vs&#46; 4&#46;4&#37;&#47;year&#41; and earlier &#40;55&#37; on the day of the procedure vs&#46; 50&#37; between 45 days and one year&#41; than in the control group&#46; The most frequent safety event in the intervention group was severe pericardial effusion&#44; seen in 4&#46;8&#37; of patients &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>22&#41;&#44; requiring surgery in seven cases but resolved by pericardiocentesis in the others&#44; with no associated mortality&#46; The frequency of this complication&#44; which was more common in the first three patients &#40;7&#46;1&#37;&#41; than in the others &#40;4&#46;4&#37;&#41; in all centers&#44; declined as operator experience increased&#46;</p><p id="par0295" class="elsevierStylePara elsevierViewall">There was device embolization in three patients&#59; one was identified during the procedure and the device was successfully removed percutaneously&#44; and two others were asymptomatic&#44; only being detected by TEE after 45 days and removed surgically&#46;</p><p id="par0300" class="elsevierStylePara elsevierViewall">The authors concluded that in terms of efficacy&#44; percutaneous closure was not inferior to warfarin&#44; even when patients at lower thromboembolic risk &#40;CHADS<span class="elsevierStyleInf">2</span> score 1&#41; were excluded&#46; With regard to safety&#44; the most common complications became less frequent as operators gained experience with the procedure&#44; and none led to permanent disability or death&#46; They suggested that the initial risk associated with device implantation was less than the cumulative risk of chronic warfarin therapy&#46;</p><p id="par0305" class="elsevierStylePara elsevierViewall">The main limitation to applying these results to all AF patients was the inclusion of patients at low embolic risk &#40;65&#37; with CHADS<span class="elsevierStyleInf">2</span> score 1 or 2&#41;&#46; It is not known to what extent they would be reproducible in a higher-risk population&#44; particularly with contraindication for warfarin&#46;</p><p id="par0310" class="elsevierStylePara elsevierViewall">In view of these findings&#44; the FDA recommended a longer follow-up period and an ongoing registry was established to assess the safety of LAA closure with the Watchman device &#8211; the Continued Access Protocol &#40;CAP&#41; Registry&#46;<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">39</span></a></p><p id="par0315" class="elsevierStylePara elsevierViewall">This registry&#44; published in January 2011&#44; included the 542 patients who underwent attempted LAA device closure in the intervention group of the PROTECT AF trial and a further 460 patients from 26 centers that participated in the trial with the same inclusion criteria&#44; follow-up and medication&#46; The authors emphasized the importance of flushing the sheath with saline to minimize the chance of air embolism&#46;</p><p id="par0320" class="elsevierStylePara elsevierViewall">Median follow-up was 2&#46;5 years for PROTECT AF &#40;0&#8211;4&#46;7 years&#41; and 0&#46;4 years for CAP &#40;0&#8211;1&#46;6 years&#41;&#46;</p><p id="par0325" class="elsevierStylePara elsevierViewall">The efficacy composite endpoint was similar to that of PROTECT AF&#46; Pericardial effusions were considered serious if they extended hospitalization&#46;</p><p id="par0330" class="elsevierStylePara elsevierViewall">The populations of the two studies differed mainly in age and CHADS<span class="elsevierStyleInf">2</span> score&#44; which were higher in CAP &#40;mean age 74<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>8 vs&#46; 72<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>9 and CHADS<span class="elsevierStyleInf">2</span> score 2&#46;4<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;2 vs&#46; 2&#46;2<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;2&#44; p&#60;0&#46;001 for both&#41;&#46;</p><p id="par0335" class="elsevierStylePara elsevierViewall">To assess the effect of the learning curve and operator experience&#44; the results of CAP and PROTECT AF were compared&#44; and the first half of the PROTECT AF patient cohort was compared with the second half of the cohort&#44; as well as the first three patients enrolled at each site in PROTECT AF with all subsequent patients enrolled at that site&#46; There was a reduction in mean procedure time&#44; an increase in implantation success&#44; and a decline in the number of safety events&#44; serious pericardial effusions and procedural stroke between the first and second halves of PROTECT AF and between the second half of PROTECT AF and CAP &#40;<a class="elsevierStyleCrossRef" href="#tbl0025">Table 5</a>&#41;&#44; the event rate in the second half of PROTECT AF &#40;5&#46;5&#37;&#41; being close to that seen in CAP &#40;3&#46;7&#37;&#41;&#46; Comparing the first three patients with all subsequent patients at each site&#44; mean procedure time improved by 33&#37; and the safety event rate improved by 52&#37; &#40;<a class="elsevierStyleCrossRef" href="#tbl0025">Table 5</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0025"></elsevierMultimedia><p id="par0340" class="elsevierStylePara elsevierViewall">The time dependence of safety events was assessed by separating those that occurred within seven days of the procedure from those in the remainder of follow-up&#59; overall&#44; 94&#37; of these events occurred in the first seven days &#40;91&#37; in PROTECT AF and 100&#37; in CAP&#41;&#46; Serious pericardial effusion was observed in 3&#46;8&#37; of patients &#40;5&#46;2&#37; in PROTECT AF and 2&#46;2&#37; in CAP&#41;&#46; The procedure-related stroke rate was 0&#46;9&#37; in PROTECT AF and zero in CAP&#46; In PROTECT AF&#44; device embolization occurred in 0&#46;6&#37; of patients vs&#46; 0&#37; in CAP&#46; Device-associated thrombus was observed in 4&#46;2&#37; &#40;20&#41; of patients in PROTECT AF and in none in CAP&#46;</p><p id="par0345" class="elsevierStylePara elsevierViewall">Another important analysis of the PROTECT AF results was to determine the functional impact of adverse events&#44; identifying those that resulted in death or significant disability &#40;defined as an increase in the modified Rankin score&#41;&#46; This analysis revealed that regardless of how &#8220;significant&#8221; is defined &#40;change in Rankin score of &#8805;1&#44; &#8805;2 or &#8805;3&#41;&#44; the safety event rate with functional impact was lower in the intervention group than in the control group&#44; with a relative risk of &#8776;0&#46;40 &#40;<a class="elsevierStyleCrossRef" href="#tbl0030">Table 6</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0030"></elsevierMultimedia><p id="par0350" class="elsevierStylePara elsevierViewall">The authors concluded that safety events in the Watchman group were largely procedure-related&#44; that these safety events decreased in frequency with greater operator experience&#44; and that they led to less significant disability than those related to warfarin therapy&#44; which accumulate linearly over time&#46;<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">39</span></a></p><p id="par0355" class="elsevierStylePara elsevierViewall">The protocols of both PROTECT AF and the CAP registry included a 45-day period of warfarin medication after percutaneous LAA closure&#44; which limits their application to patients with contraindication to oral anticoagulation&#44; for whom this procedure could be an alternative&#46; The ASA Plavix Feasibility Study With WATCHMAN Left Atrial Appendage Closure Technology &#40;ASAP&#41;&#44;<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">40</span></a> a prospective non-randomized registry&#44; was set up to assess the efficacy of percutaneous LAA closure in these patients&#46; It has the same inclusion and exclusion criteria as PROTECT AF&#44; except for contraindication to warfarin&#44; and includes 150 patients with non-valvular AF in three centers in Germany and one in the Czech Republic who underwent percutaneous closure with the Watchman device&#46; After the procedure patients took clopidogrel for six months and aspirin indefinitely&#44; and underwent TEE at three and 12 months&#46; Preliminary results were presented at the Heart Rhythm Society 2012 Scientific Sessions&#46;<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">41</span></a> Implantation was successful in 94&#37; of patients &#40;141&#47;150&#41;&#46; In a follow-up of 14&#46;2<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>8&#46;7 months there was one systemic embolization&#44; six cases of device-related thrombus and four strokes&#44; an ischemic stroke rate of 1&#46;8&#37;&#44; which according to the authors corresponds to a 75&#37; reduction in events compared to that expected on the basis of a mean CHADS<span class="elsevierStyleInf">2</span> score of 2&#46;8<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;2 if they had been taking aspirin alone &#40;7&#46;1&#37;&#41; and a 64&#37; reduction compared to that expected under treatment with aspirin and clopidogrel indefinitely &#40;5&#37;&#41;&#46; The authors concluded that implantation of the Watchman device was safe and effective without temporary warfarin therapy in patients with contraindication to oral anticoagulation&#46;<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">41</span></a></p><p id="par0360" class="elsevierStylePara elsevierViewall">Incomplete closure of the LAA by surgical methods increases risk for embolic events&#44; but it was not known whether this was also true of incomplete percutaneous closure&#46; Viles-Gonzalez et al&#46; accordingly performed a retrospective analysis of the intervention group of PROTECT AF&#44; published in March 2012&#46;<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">42</span></a> They assessed peri-device blood flow&#44; classified as minor&#44; moderate&#44; or major &#40;&#60;1<span class="elsevierStyleHsp" style=""></span>mm&#44; 1&#8211;3<span class="elsevierStyleHsp" style=""></span>mm&#44; and &#62;3<span class="elsevierStyleHsp" style=""></span>mm&#44; respectively&#41;&#44; by TEE at 45 days&#44; six and 12 months&#46; Of the 485 patients with a successfully implanted Watchman device&#44; only 445 underwent TEE at 45 days&#44; 414 at six months and 389 at 12 months&#46; The prevalence of any flow around the device decreased with time from 40&#46;9&#37; at the 45-day TEE&#44; to 33&#46;8&#37; at six months&#44; and to 32&#46;1&#37; at 12 months &#40;p&#61;0&#46;001&#41;&#46; The severity of the flow at 45 days was minor in 7&#46;7&#37;&#44; moderate in 59&#46;9&#37; and major in 32&#46;4&#37;&#59; this distribution did not change significantly at six or 12 months &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;731&#41;&#46; The mean and maximum width of the leak were 2&#46;8 and 6&#46;2<span class="elsevierStyleHsp" style=""></span>mm&#44; 2&#46;9 and 6&#46;8<span class="elsevierStyleHsp" style=""></span>mm&#44; and 2&#46;9 and 6&#46;0<span class="elsevierStyleHsp" style=""></span>mm&#44; at 45 days&#44; six months&#44; and 12 months&#44; respectively&#46;</p><p id="par0365" class="elsevierStylePara elsevierViewall">There were no significant differences in the efficacy endpoint of PROTECT AF between patients with peri-device flow &#40;2&#46;8&#37;&#41; and those without &#40;2&#37;&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;635&#41;&#44; or between those with any flow and no flow &#40;hazard ratio &#91;HR&#93; 0&#46;85&#44; 0&#46;83 and 0&#46;48 for minor&#44; moderate and major flow&#44; respectively&#44; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;798&#41;&#46; The impact of 1-mm increases in flow size on this endpoint was also analyzed and there was no significant difference between the groups &#40;HR 0&#46;84&#44; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;256&#41;&#46;</p><p id="par0370" class="elsevierStylePara elsevierViewall">Analysis of a second endpoint of stroke and systemic embolization again showed no significant relationship with the presence or severity of peri-device flow&#46;</p><p id="par0375" class="elsevierStylePara elsevierViewall">This analysis was also performed separately for patients who continued warfarin therapy after 45 days and those who discontinued it at that point&#44; once again without showing any difference regarding the presence of peri-device flow &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;857&#41;&#46;</p><p id="par0380" class="elsevierStylePara elsevierViewall">The authors concluded that in this sample there was no relationship between the presence of residual peri-device flow and embolic events&#44; although with the caveat that these results may not be applicable to devices other than the Watchman&#44; and suggest that different devices should be analyzed in the same way&#46;<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">42</span></a></p><p id="par0385" class="elsevierStylePara elsevierViewall">A second randomized clinical trial on the Watchman device is under way&#44; the PREVAIL study&#46;<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">43</span></a> This has a similar structure to PROTECT AF&#44; except that patients with CHADS<span class="elsevierStyleInf">2</span> score of 1 are only included if any of the following apply&#58; female age 75 or older&#59; left ventricular ejection fraction &#8805;30 and &#60;35&#37;&#44; aged 65&#8211;74 and has diabetes or coronary artery disease&#44; or aged &#8805;65 and has congestive heart failure&#46;</p></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Conclusions</span><p id="par0390" class="elsevierStylePara elsevierViewall">The development of percutaneous LAA closure was an important step in the prevention of cardioembolic events in AF&#44; particularly in non-valvular AF&#46; The feasibility of the technique has been demonstrated in various studies&#44; the most important of which&#44; PROTECT AF&#44; showed similar efficacy to warfarin in prevention of thromboembolic events&#44; although with a higher rate of safety events&#44; particularly procedure-related&#46; Longer follow-up of these patients and the establishment of the CAP registry have produced encouraging results for continued use of the technique&#44; since they show that procedure-related complications decline with greater operator experience and lead to lower mortality and disability than warfarin therapy&#44; suggesting that LAA closure has a better long-term safety profile&#46;</p><p id="par0395" class="elsevierStylePara elsevierViewall">These findings demonstrate that percutaneous LAA closure is a valid alternative for thromboembolic prevention in high-risk patients with non-valvular AF without contraindication for oral anticoagulation&#44; although it has mainly been used in patients in whom anticoagulation is contraindicated&#44; for obvious reasons&#46; However&#44; reports of a particularly serious complication &#8211; the formation of thrombi on the device &#8211; have cooled the initial enthusiasm generated by the technique and raised the possibility that a period of anticoagulation may be necessary after implantation in some patients&#46;</p><p id="par0400" class="elsevierStylePara elsevierViewall">Unlike the data on incomplete surgical LAA occlusion&#44; incomplete closure with the Watchman device was not associated with embolic events in the only trial performed to date&#46;</p><p id="par0405" class="elsevierStylePara elsevierViewall">Although further studies are needed to assess possible late complications related to these devices and to determine any physiological consequences of LAA closure &#40;about which little is known&#41;&#44; percutaneous LAA closure appears to be a safe and effective alternative to oral anticoagulation in high-risk patients&#44; and may also become a valid alternative for low-risk patients&#46; The role of new oral anticoagulants in thromboembolic prevention will also be important in determining which patients would benefit from percutaneous LAA closure&#46;</p></span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Ethical disclosures</span><span id="sec0075" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Protection of human and animal subjects</span><p id="par0410" class="elsevierStylePara elsevierViewall">The authors declare that no experiments were performed on humans or animals for this study&#46;</p></span><span id="sec0080" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Confidentiality of data</span><p id="par0415" class="elsevierStylePara elsevierViewall">The authors declare that no patient data appear in this article&#46;</p></span><span id="sec0085" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Right to privacy and informed consent</span><p id="par0420" class="elsevierStylePara elsevierViewall">The authors declare that no patient data appear in this article&#46;</p></span></span><span id="sec0090" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Conflicts of interest</span><p id="par0425" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare&#46;</p></span></span>"
    "textoCompletoSecciones" => array:1 [
      "secciones" => array:20 [
        0 => array:2 [
          "identificador" => "xres251697"
          "titulo" => "Abstract"
        ]
        1 => array:2 [
          "identificador" => "xpalclavsec239294"
          "titulo" => "Keywords"
        ]
        2 => array:2 [
          "identificador" => "xres251698"
          "titulo" => "Resumo"
        ]
        3 => array:2 [
          "identificador" => "xpalclavsec239295"
          "titulo" => "Palavras-chave"
        ]
        4 => array:2 [
          "identificador" => "sec0005"
          "titulo" => "Introduction"
        ]
        5 => array:2 [
          "identificador" => "sec0010"
          "titulo" => "Prevalence of atrial fibrillation"
        ]
        6 => array:2 [
          "identificador" => "sec0015"
          "titulo" => "The importance of thromboembolism in atrial fibrillation"
        ]
        7 => array:2 [
          "identificador" => "sec0020"
          "titulo" => "Chronic anticoagulation with warfarin"
        ]
        8 => array:2 [
          "identificador" => "sec0025"
          "titulo" => "New oral anticoagulants"
        ]
        9 => array:2 [
          "identificador" => "sec0030"
          "titulo" => "The importance of the left atrial appendage in thromboembolism"
        ]
        10 => array:2 [
          "identificador" => "sec0035"
          "titulo" => "Surgical exclusion of the LAA"
        ]
        11 => array:2 [
          "identificador" => "sec0040"
          "titulo" => "Minimally invasive LAA exclusion"
        ]
        12 => array:2 [
          "identificador" => "sec0045"
          "titulo" => "Endocardial percutaneous LAA closure"
        ]
        13 => array:2 [
          "identificador" => "sec0050"
          "titulo" => "The PLAATO device"
        ]
        14 => array:2 [
          "identificador" => "sec0055"
          "titulo" => "Amplatzer devices"
        ]
        15 => array:2 [
          "identificador" => "sec0060"
          "titulo" => "The Watchman left atrial appendage system"
        ]
        16 => array:2 [
          "identificador" => "sec0065"
          "titulo" => "Conclusions"
        ]
        17 => array:3 [
          "identificador" => "sec0070"
          "titulo" => "Ethical disclosures"
          "secciones" => array:3 [
            0 => array:2 [
              "identificador" => "sec0075"
              "titulo" => "Protection of human and animal subjects"
            ]
            1 => array:2 [
              "identificador" => "sec0080"
              "titulo" => "Confidentiality of data"
            ]
            2 => array:2 [
              "identificador" => "sec0085"
              "titulo" => "Right to privacy and informed consent"
            ]
          ]
        ]
        18 => array:2 [
          "identificador" => "sec0090"
          "titulo" => "Conflicts of interest"
        ]
        19 => array:1 [
          "titulo" => "References"
        ]
      ]
    ]
    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "fechaRecibido" => "2012-03-18"
    "fechaAceptado" => "2012-06-18"
    "PalabrasClave" => array:2 [
      "en" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec239294"
          "palabras" => array:6 [
            0 => "Atrial fibrillation"
            1 => "Thromboembolism"
            2 => "Stroke"
            3 => "Left atrial appendage"
            4 => "Anticoagulation"
            5 => "Cardiac implant"
          ]
        ]
      ]
      "pt" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palavras-chave"
          "identificador" => "xpalclavsec239295"
          "palabras" => array:6 [
            0 => "Fibrilha&#231;&#227;o auricular"
            1 => "Tromboembolismo"
            2 => "Acidente vascular cerebral"
            3 => "Ap&#234;ndice auricular esquerdo"
            4 => "Anticoagula&#231;&#227;o oral"
            5 => "Implante card&#237;aco"
          ]
        ]
      ]
    ]
    "tieneResumen" => true
    "resumen" => array:2 [
      "en" => array:2 [
        "titulo" => "Abstract"
        "resumen" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Atrial fibrillation is a common arrhythmia in clinical practice&#46; It is associated with high morbidity and mortality due to its thromboembolic potential&#44; which makes thromboembolic prevention particularly important&#46; Warfarin has been the first-line therapy for this purpose&#44; but it has various limitations and is often contraindicated or underutilized&#46; The fact that thrombi are frequently located in the left atrial appendage in atrial fibrillation led to the development of percutaneous closure for thromboembolic prevention&#46; This article examines the current evidence on percutaneous closure of the left atrial appendage by reviewing the results of the numerous clinical trials on the technique&#46;</p>"
      ]
      "pt" => array:2 [
        "titulo" => "Resumo"
        "resumen" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">A fibrilha&#231;&#227;o auricular &#233; uma arritmia frequente na pr&#225;tica cl&#237;nica&#46; Associa-se &#224; morbilidade e &#224; mortalidade elevadas&#44; em virtude do seu potencial tromboemb&#243;lico&#44; o que confere especial relev&#226;ncia &#224; profilaxia do tromboembolismo&#46; Para este efeito&#44; a varfarina tem sido a terap&#234;utica de primeira linha&#44; no entanto&#44; associa-se a in&#250;meras limita&#231;&#245;es&#44; que a tornam contraindicada ou sub-utilizada&#46; A localiza&#231;&#227;o frequente no ap&#234;ndice auricular esquerdo dos trombos formados na fibrilha&#231;&#227;o auricular conduziu a que o seu encerramento percut&#226;neo fosse desenvolvido para profilaxia do tromboembolismo&#46; Este artigo pretende fazer um enquadramento da evid&#234;ncia atual para o encerramento percut&#226;neo do ap&#234;ndice auricular esquerdo&#44; atrav&#233;s de uma revis&#227;o e atualiza&#231;&#227;o dos resultados dos in&#250;meros estudos realizados at&#233; ao momento&#46;</p>"
      ]
    ]
    "NotaPie" => array:1 [
      0 => array:2 [
        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara">Please cite this article as&#58; Faustino A&#44; et al&#46; Encerramento percut&#226;neo do ap&#234;ndice auricular esquerdo para profilaxia de tromboembolismo na fibrilha&#231;&#227;o auricular&#46; Rev Port Cardiol&#46; 2013&#46; <span class="elsevierStyleInterRef" href="http://dx.doi.org/10.1016/j.repc.2012.06.017">http&#58;&#47;&#47;dx&#46;doi&#46;org&#47;10&#46;1016&#47;j&#46;repc&#46;2012&#46;06&#46;017</span>&#46;</p>"
      ]
    ]
    "multimedia" => array:9 [
      0 => array:7 [
        "identificador" => "fig0005"
        "etiqueta" => "Figure 1"
        "tipo" => "MULTIMEDIAFIGURA"
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        "figura" => array:1 [
          0 => array:4 [
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        "descripcion" => array:1 [
          "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">The PLAATO device &#40;ev3 Inc&#46;&#44; Plymouth&#44; MN&#41;&#46; LA&#58; left atrium&#59; LAA&#58; left atrial appendage&#46; Adapted from<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">27</span></a>&#46;</p>"
        ]
      ]
      1 => array:7 [
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        "etiqueta" => "Figure 2"
        "tipo" => "MULTIMEDIAFIGURA"
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            "imagen" => "gr2.jpeg"
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        "descripcion" => array:1 [
          "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">The Amplatzer Cardiac Plug &#40;St&#46; Jude Medical&#44; Plymouth&#44; MN&#41;&#46; Adapted from<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">32</span></a>&#46;</p>"
        ]
      ]
      2 => array:7 [
        "identificador" => "fig0015"
        "etiqueta" => "Figure 3"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
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          "en" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">The Watchman device &#40;Boston Scientific&#44; Plymouth&#44; MN&#41;&#46; Adapted from<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a>&#46;</p>"
        ]
      ]
      3 => array:8 [
        "identificador" => "tbl0005"
        "etiqueta" => "Table 1"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "fuente" => "Adapted from<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">28</span></a>&#46;"
        "tabla" => array:2 [
          "leyenda" => "<p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">LAA&#58; left atrial appendage&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Degree of occlusion&#47;type of leak&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Flow on angiography&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#58; Severe&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Completely fills the LAA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#58; Moderate&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Fills two-thirds of the LAA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#58; Mild&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Fills one-third of the LAA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#58; Trace or absent&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Barely detectable or no blush&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab355033.png"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Angiographic classification of left atrial appendage closure&#46; Successful closure was defined by a leak of degree 3 or 4&#46;</p>"
        ]
      ]
      4 => array:8 [
        "identificador" => "tbl0010"
        "etiqueta" => "Table 2"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "fuente" => "Adapted from<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">28</span></a>&#46;"
        "tabla" => array:1 [
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Degree of occlusion&#47;type of leak&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Color Doppler flow&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#58; Severe&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Multiple jets of free flow&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#58; Moderate&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#62;3<span class="elsevierStyleHsp" style=""></span>mm diameter jet&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#58; Mild&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#8211;3<span class="elsevierStyleHsp" style=""></span>mm diameter jet&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#58; Trace leak&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;1<span class="elsevierStyleHsp" style=""></span>mm diameter jet&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&#58; Absent leak&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">No jet&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
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          "en" => "<p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Classification of LAA closure by color Doppler echocardiography&#46; Successful LAA occlusion was defined as a grade of 3 or higher&#46;</p>"
        ]
      ]
      5 => array:7 [
        "identificador" => "tbl0015"
        "etiqueta" => "Table 3"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
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        "tabla" => array:2 [
          "leyenda" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">AF&#58; atrial fibrillation&#59; CAD&#58; coronary artery disease&#59; LAA&#58; left atrial appendage&#59; OAC&#58; oral anticoagulation&#59; TEE&#58; transesophageal echocardiography&#59; TIA&#59; transient ischemic attack&#59; TTE&#58; transthoracic echocardiography&#46;</p><p id="spar0055" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleSup">a</span>TTE criteria &#8211; flow velocity in the LAA &#60;20<span class="elsevierStyleHsp" style=""></span>cm&#47;s or moderate or dense spontaneous echocardiographic contrast&#46;</p><p id="spar0060" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleSup">b</span>Requiring treatment &#40;pericardiocentesis or surgery&#41;&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Trial&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Sievert et al&#46;<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">27</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Ostermayer et al&#46;<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">28</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Park et al&#46;<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">29</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Block et al&#46;<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">30</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Design</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Prospective1 centerEurope&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Prospective5 centersEurope<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>N&#46; America&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Prospective1 centerEurope&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Prospective10 centersN&#46; America&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Year of publication</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2002&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2005&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2009&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2009&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Sample size &#40;n&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">15&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">111&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">73&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">64&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Inclusion criteria</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">- Chronic non-rheumatic AF- High TE risk &#40;CHADS<span class="elsevierStyleInf">2</span> score &#8805;1 or spontaneous echo contrast in the LAA&#41;- Contraindication to OAC&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">- Non-rheumatic AF &#8805;3 months duration- High TE risk &#40;&#8805;1 in Europe or &#8805;2 in N&#46; America&#58; CAD&#44; CHADS<span class="elsevierStyleInf">2</span> score or TEE criteria&#42;&#41;- Contraindication to OAC&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">- Rheumatic or non-rheumatic chronic or paroxysmal AF- Contraindication to OAC or embolic stroke under OAC&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">- Non-valvular chronic or paroxysmal AF- CHADS<span class="elsevierStyleInf">2</span> score &#8805;2- Contraindication to OAC&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">CHADS</span><span class="elsevierStyleInf"><span class="elsevierStyleItalic">2</span></span><span class="elsevierStyleItalic">score</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Not specified&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#46;5<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#46;5<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Post-procedural medication</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">- Aspirin 300<span class="elsevierStyleHsp" style=""></span>mg&#47;day indefinitely- Clopidogrel 75<span class="elsevierStyleHsp" style=""></span>mg&#47;day 6 months&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">- Aspirin 300&#8211;325<span class="elsevierStyleHsp" style=""></span>mg&#47;day indefinitely- Clopidogrel 75<span class="elsevierStyleHsp" style=""></span>mg&#47;day N&#46; America &#8211; 1&#46;5 months&#59; Europe &#8211; decision of investigator- Prophylaxis against endocarditis&#58; 6 months in N&#46; America&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">- Aspirin 100<span class="elsevierStyleHsp" style=""></span>mg&#47;day indefinitely- Clopidogrel 75<span class="elsevierStyleHsp" style=""></span>mg&#47;day 6 months&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">- Aspirin 325<span class="elsevierStyleHsp" style=""></span>mg&#47;day indefinitely- Clopidogrel 75<span class="elsevierStyleHsp" style=""></span>mg&#47;day 1&#8211;1&#46;5 months&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Device changed</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4 &#40;26&#46;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Not specified&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9 &#40;12&#46;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1 &#40;1&#46;6&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Implantation success</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">15 &#40;100&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">108 &#40;97&#46;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">71 &#40;97&#46;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">61 &#40;93&#46;85&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Procedure time</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">90<span class="elsevierStyleHsp" style=""></span>min&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">68<span class="elsevierStyleHsp" style=""></span>min&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Not specified&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Not specified&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="5" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="5" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Follow-up</span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>- Type&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">- TEE and chest X-ray&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">- TEE &#40;3&#8211;6 months&#41;- Interview at 24 months&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">- TEE&#58; 1&#44; 6 months&#58; 20 patients&#59; TTE&#58; others- Interview&#44; lab&#46; tests and chest X-ray&#58; 1&#44; 3&#44; 6&#44; 12&#44; 24&#44; 36&#44; 48&#44; and 60 months&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>- Duration&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1 month&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Design</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Prospective4 centersEurope and N&#46; America&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Retrospective10 centersEurope&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Prospective7 centersEurope and N&#46; America&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Prospective&#44; randomized&#44; controlled59 centersEurope and US&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Year of publication</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2003&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2009&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2007&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2009&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Inclusion criteria</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">- Chronic or paroxysmal AF- Others not specified&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">- Chronic or paroxysmal AF- Others not specified&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">- Chronic or paroxysmal AF- CHADS<span class="elsevierStyleInf">2</span> score &#8805;1- Eligible for OAC&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">- Age &#62;18- Non-valvular chronic&#44; persistent or paroxysmal AF- CHADS<span class="elsevierStyleInf">2</span> score &#8805;1- Eligible for OAC&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">CHADS</span><span class="elsevierStyleInf"><span class="elsevierStyleItalic">2</span></span><span class="elsevierStyleItalic">score</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Not specified&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Not specified&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Not specified&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Not specified&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Planned implantations</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">16&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">143&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">75 &#40;1st gen&#46;&#58; 16&#59; 2nd gen&#46;&#58; 59&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">449&#47;463&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Devices implanted</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">16 &#40;100&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">137 &#40;95&#46;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1st gen&#46;&#58; 14&#47;16 &#40;87&#46;5&#37;&#41;2nd gen&#46;&#58; 53&#47;59 &#40;89&#46;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">408&#47;449 &#40;intervention group&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Device changed</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0 &#40;0&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">23&#47;137 &#40;16&#46;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Not specified&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Not specified&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Implantation success</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">15 &#40;93&#46;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">132&#47;137 &#40;96&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1st gen&#46;&#58; 13&#47;14 &#40;92&#46;8&#37;&#41;2nd gen&#46;&#58; 53&#47;53 &#40;100&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">408&#47;449 &#40;90&#46;9&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Procedure time</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Not specified&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Not specified&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Not specified&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Not specified&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Device embolization</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1 &#40;6&#46;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#47;137 &#40;1&#46;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1st gen&#46;&#58; 2&#47;14 &#40;14&#46;3&#37;&#41;2nd gen&#46;&#58; 0&#47;53 &#40;0&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#47;449 &#40;0&#46;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Pericardial effusion</span><a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0 &#40;0&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&#47;137 &#40;3&#46;6&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1st gen&#46;&#58; 1&#47;14 &#40;7&#46;1&#37;&#41;2nd gen&#46;&#58; 1&#47;53 &#40;1&#46;9&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">22&#47;449 &#40;4&#46;9&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Device thrombus</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0 &#40;0&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Not specified&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1st gen&#46;&#58; 0&#47;14 &#40;0&#37;&#41;2nd gen&#46;&#58; 4&#47;53 &#40;7&#46;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Not specified&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Post-procedural medication</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">- 1 center&#58; warfarin for 6 weeks&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Not specified&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">- Aspirin &#40;81&#8211;100<span class="elsevierStyleHsp" style=""></span>mg&#47;day&#41; indefinitely- Warfarin 45 days- Later patients&#58; clopidogrel 75<span class="elsevierStyleHsp" style=""></span>mg&#47;day from 45th day to 6 months&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">- Aspirin &#40;81&#8211;325<span class="elsevierStyleHsp" style=""></span>mg&#47;day&#41; indefinitely- Warfarin 45 days- Clopidogrel 75<span class="elsevierStyleHsp" style=""></span>mg&#47;day from 45th day to 6 months&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="5" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="5" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Follow-up</span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>- Type&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">- TEE&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Not specified&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">- TEE at 45 days&#44; 6 months&#44; then annually until 5 years&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">- TEE at 45 days- Clinical&#58; at 45 days&#44; 6&#44; 9&#44; and 12 months&#44; then twice yearly- Neurological&#58; initial&#44; 6&#44; 9&#44; and 12 months&#44; then twice yearly&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>- Duration&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4 months&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Not specified&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">24 months&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">18 months&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="5" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Stroke&#47;TIA</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0 &#40;0&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3 &#40;2&#46;2&#37;&#41;&#47;0 &#40;0&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0 &#40;0&#37;&#41;&#47;2 &#40;2&#46;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">15&#47;694&#46;6 &#40;2&#46;2&#37;&#41;&#47;not specified&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="5" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="5" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Stroke</span><span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">TIA&#47;year</span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>- Observed&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0 &#40;0&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Not specified&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Not specified&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Not specified&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>- Predicted &#40;CHADS<span class="elsevierStyleInf">2</span>&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Not specified&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Not specified&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;9&#37; stroke&#47;year&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Not specified&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="5" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="5" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Mortality</span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>- Procedural&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0 &#40;0&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Not specified&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0 &#40;0&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#47;463 &#40;0&#46;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>- Non-procedural&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0 &#40;0&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Not specified&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#47;75 &#40;2&#46;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">19&#47;463 &#40;4&#46;1&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="5" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Surgery for procedural complications</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1 &#40;6&#46;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0 &#40;0&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1st gen&#46;&#58; 1&#47;14 &#40;7&#46;1&#37;&#41;2nd gen&#46;&#58; 0&#47;53 &#40;0&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8&#47;449 &#40;1&#46;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">PROTECT AF&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " colspan="2" align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">PROTECT AF</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " colspan="2" align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">PROTECT AF</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">CAP&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">p<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">p<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">p<a class="elsevierStyleCrossRef" href="#tblfn0020"><span class="elsevierStyleSup">c</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">1st half&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">2nd half&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">1st three patients&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Subsequent&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Procedure time &#40;min&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">62<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>34&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">67<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>36&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">58<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>33&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">82<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>40&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">55<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>29&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">50<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>21&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Implantation success&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">485&#47;542 &#40;89&#46;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">239&#47;271 &#40;88&#46;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">246&#47;271 &#40;90&#46;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">133&#47;154 &#40;86&#46;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">352&#47;388 &#40;90&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">437&#47;460 &#40;95&#46;0&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">0&#46;001&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#46;001&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Safety events in the 1st 7 days&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
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                  \t\t\t\t">27&#47;271 &#40;10&#46;0&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
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                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">19&#47;154 &#40;12&#46;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">23&#47;388 &#40;5&#46;9&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">17&#47;460 &#40;3&#46;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">0&#46;007&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;006&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;012&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Serious pericardial effusion in the 1st 7 days&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">27&#47;542 &#40;5&#46;0&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">17&#47;271 &#40;6&#46;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10&#47;271 &#40;3&#46;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10&#47;154 &#40;6&#46;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">17&#47;388 &#40;4&#46;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10&#47;460 &#40;2&#46;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">0&#46;019&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;018&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;308&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Procedure-related stroke&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&#47;542 &#40;0&#46;9&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#47;271 &#40;1&#46;1&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#47;271 &#40;0&#46;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#47;154 &#40;0&#46;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#47;388 &#40;1&#46;0&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#47;460 &#40;0&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;039&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;039&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;675&nbsp;\t\t\t\t\t\t\n
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                  """
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            1 => array:3 [
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            2 => array:3 [
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              "etiqueta" => "c"
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                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Intervention groupn&#47;total &#40;&#37;&#47;year&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Control groupn&#47;total year&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttop\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">Death or MRS<span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">19&#47;1042&#46;2 &#40;1&#46;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">24&#47;559&#46;5 &#40;4&#46;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;43 &#40;0&#46;24&#8211;0&#46;82&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Death or MRS<span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">16&#47;1047&#46;1 &#40;1&#46;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                    0 => array:2 [
                      "titulo" => "Preval&#234;ncia de fibrilha&#231;&#227;o auricular na popula&#231;&#227;o portuguesa com 40 ou mais anos&#46; Estudo FAMA"
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                        0 => array:2 [
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                          "autores" => array:3 [
                            0 => "D&#46; Bonhorst"
                            1 => "M&#46; Mendes"
                            2 => "P&#46; Adrag&#227;o"
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                      ]
                    ]
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                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Rev Port Cardiol"
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                        "volumen" => "29"
                        "paginaInicial" => "331"
                        "paginaFinal" => "350"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20635561"
                            "web" => "Medline"
                          ]
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                      ]
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                ]
              ]
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            1 => array:3 [
              "identificador" => "bib0010"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Guidelines for the management of atrial fibrillation&#58; The Task Force for the Management of AtrialFibrillation of the European Society of Cardiology &#40;ESC&#41;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "A&#46;J&#46; Camm"
                            1 => "P&#46; Kirchhof"
                            2 => "G&#46;Y&#46; Lip"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1093/eurheartj/ehq278"
                      "Revista" => array:6 [
                        "tituloSerie" => "Eur Heart J"
                        "fecha" => "2010"
                        "volumen" => "31"
                        "paginaInicial" => "2369"
                        "paginaFinal" => "2429"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20802247"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib0015"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Outcome parameters for trials in atrial fibrillation&#58; executive summary"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "P&#46; Kirchhof"
                            1 => "A&#46; Auricchio"
                            2 => "J&#46; Bax"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1093/eurheartj/ehm358"
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                        "tituloSerie" => "Eur Heart J"
                        "fecha" => "2007"
                        "volumen" => "28"
                        "paginaInicial" => "2803"
                        "paginaFinal" => "2817"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17897924"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib0020"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Left atrial appendage closure in atrial fibrillation&#58; a world without anticoagulation&#63;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "T&#46; Contractor"
                            1 => "A&#46; Khasnis"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Cardiol Res Pract"
                        "fecha" => "2011"
                        "volumen" => "2011"
                        "paginaInicial" => "752"
                        "paginaFinal" => "808"
                      ]
                    ]
                  ]
                ]
              ]
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            4 => array:3 [
              "identificador" => "bib0025"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Percutaneous closure of the left atrial appendage&#58; a major step forward"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "H&#46; Sievert"
                            1 => "Y&#46;L&#46; Bayard"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.jcin.2009.05.013"
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                        "tituloSerie" => "JACC Cardiovasc Interv"
                        "fecha" => "2009"
                        "volumen" => "2"
                        "paginaInicial" => "601"
                        "paginaFinal" => "602"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19628180"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            5 => array:3 [
              "identificador" => "bib0030"
              "etiqueta" => "6"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Stroke in paroxysmal atrial fibrillation&#58; report from the Stockholm Cohort of Atrial Fibrillation"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "L&#46; Friberg"
                            1 => "N&#46; Hammar"
                            2 => "M&#46; Rosenqvist"
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                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1093/eurheartj/ehn599"
                      "Revista" => array:6 [
                        "tituloSerie" => "Eur Heart J"
                        "fecha" => "2010"
                        "volumen" => "31"
                        "paginaInicial" => "967"
                        "paginaFinal" => "975"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19176537"
                            "web" => "Medline"
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                      ]
                    ]
                  ]
                ]
              ]
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            6 => array:3 [
              "identificador" => "bib0035"
              "etiqueta" => "7"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Meta-analysis&#58; antithrombotic therapy to prevent stroke in patients who have nonvalvular atrial fibrillation"
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                          "etal" => false
                          "autores" => array:3 [
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                    ]
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                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Ann Intern Med"
                        "fecha" => "2007"
                        "volumen" => "146"
                        "paginaInicial" => "857"
                        "paginaFinal" => "867"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17577005"
                            "web" => "Medline"
                          ]
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              ]
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              "identificador" => "bib0040"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Percutaneous closure of the left atrial appendage versus warfarin therapy for prevention of stroke in patients with atrial fibrillation&#58; a randomized non-inferiority trial"
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                        0 => array:2 [
                          "etal" => true
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                    ]
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                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/S0140-6736(09)61343-X"
                      "Revista" => array:6 [
                        "tituloSerie" => "Lancet"
                        "fecha" => "2009"
                        "volumen" => "374"
                        "paginaInicial" => "534"
                        "paginaFinal" => "542"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19683639"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
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              "identificador" => "bib0045"
              "etiqueta" => "9"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The PROTECT AF &#40;WATCMAN Left Atrial Appendage System for Embolic PROTECTion in Patients with Atrial Fibrillation&#41; trial"
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                        0 => array:2 [
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                        "tituloSerie" => "Am Heart J"
                        "fecha" => "2006"
                        "volumen" => "151"
                        "paginaInicial" => "956"
                        "paginaFinal" => "961"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16644311"
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                          ]
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              "identificador" => "bib0050"
              "etiqueta" => "10"
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                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "Effect of clopidogrel added to aspirin in patients with atrial fibrillation"
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                          "autores" => array:3 [
                            0 => "S&#46;J&#46; Connolly"
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                        ]
                      ]
                    ]
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                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1056/NEJMoa0901301"
                      "Revista" => array:6 [
                        "tituloSerie" => "N Engl J Med"
                        "fecha" => "2009"
                        "volumen" => "360"
                        "paginaInicial" => "2066"
                        "paginaFinal" => "2078"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19336502"
                            "web" => "Medline"
                          ]
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                ]
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              "identificador" => "bib0055"
              "etiqueta" => "11"
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                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "Clopidogrel plus aspirin versus oral anticoagulation for atrial fibrillation in the Atrial fibrillation Clopidogrel Trial with Irbesartan for prevention of Vascular Events &#40;ACTIVE W&#41;&#58; a randomized controlled trial"
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                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/S0140-6736(06)68845-4"
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                        "tituloSerie" => "Lancet"
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                        "volumen" => "367"
                        "paginaInicial" => "1903"
                        "paginaFinal" => "1912"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16765759"
                            "web" => "Medline"
                          ]
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              "identificador" => "bib0060"
              "etiqueta" => "12"
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                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "Left atrial appendage exclusion for stroke prevention in patients with nonrheumatic atrial fibrillation"
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                          "etal" => false
                          "autores" => array:2 [
                            0 => "O&#46; Onalan"
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                        "paginaInicial" => "624"
                        "paginaFinal" => "630"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17261703"
                            "web" => "Medline"
                          ]
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                    ]
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                ]
              ]
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              "identificador" => "bib0065"
              "etiqueta" => "13"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Dabigatran versus warfarin in patients with atrial fibrillation"
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                    0 => array:2 [
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                        "tituloSerie" => "N Engl J Med"
                        "fecha" => "2009"
                        "volumen" => "361"
                        "paginaInicial" => "1139"
                        "paginaFinal" => "1151"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19717844"
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                          ]
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                    ]
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                ]
              ]
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              "identificador" => "bib0070"
              "etiqueta" => "14"
              "referencia" => array:1 [
                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "Rivaroxaban versus warfarin in nonvalvular atrial fibrillation"
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                          "etal" => true
                          "autores" => array:3 [
                            0 => "M&#46;R&#46; Patel"
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                      ]
                    ]
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                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1056/NEJMoa1009638"
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                        "tituloSerie" => "N Engl J Med"
                        "fecha" => "2011"
                        "volumen" => "365"
                        "paginaInicial" => "883"
                        "paginaFinal" => "891"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21830957"
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                  ]
                ]
              ]
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              "identificador" => "bib0075"
              "etiqueta" => "15"
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                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "Apixaban versus warfarin in patients with atrial fibrillation"
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                        "link" => array:1 [
                          0 => array:2 [
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                ]
              ]
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              "identificador" => "bib0080"
              "etiqueta" => "16"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Stroke prevention in atrial fibrillation&#58; atrial appendage closure"
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                            0 => "C&#46;J&#46; Fuller"
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                        "tituloSerie" => "Curr Cardiol Rep"
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                        "volumen" => "13"
                        "paginaInicial" => "159"
                        "paginaFinal" => "166"
                        "link" => array:1 [
                          0 => array:2 [
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                            "web" => "Medline"
                          ]
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                ]
              ]
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              "identificador" => "bib0085"
              "etiqueta" => "17"
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                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "Canadian Cardiovascular Society Atrial Fibrillation Guidelines 2010&#58; prevention of stroke and systemic thromboembolism in atrial fibrillation and flutter"
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                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
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                        ]
                      ]
                    ]
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                  "host" => array:1 [
                    0 => array:2 [
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                        "tituloSerie" => "Can J Cardiol"
                        "fecha" => "2011"
                        "volumen" => "27"
                        "paginaInicial" => "74"
                        "paginaFinal" => "90"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21329865"
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                ]
              ]
            ]
            17 => array:3 [
              "identificador" => "bib0090"
              "etiqueta" => "18"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Appendage obliteration to reduce stroke in cardiac surgical patients with atrial fibrillation"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "J&#46;L&#46; Blackshear"
                            1 => "J&#46;A&#46; Odell"
                          ]
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                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/0003-4975(95)00887-X"
                      "Revista" => array:6 [
                        "tituloSerie" => "Ann Thorac Surg"
                        "fecha" => "1996"
                        "volumen" => "61"
                        "paginaInicial" => "755"
                        "paginaFinal" => "759"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8572814"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            18 => array:3 [
              "identificador" => "bib0095"
              "etiqueta" => "19"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Use of transesophageal echocardiography to guide cardioversion in patients with atrial fibrillation"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "A&#46;L&#46; Klein"
                            1 => "R&#46;A&#46; Grimm"
                            2 => "R&#46;D&#46; Murray"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1056/NEJM200105103441901"
                      "Revista" => array:6 [
                        "tituloSerie" => "N Engl J Med"
                        "fecha" => "2001"
                        "volumen" => "344"
                        "paginaInicial" => "1411"
                        "paginaFinal" => "1420"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11346805"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            19 => array:3 [
              "identificador" => "bib0100"
              "etiqueta" => "20"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Initial worldwide experience with the WATCHMAN left atrial appendage system for stroke prevention in atrial fibrillation"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "P&#46;B&#46; Sick"
                            1 => "G&#46; Schuler"
                            2 => "K&#46;E&#46; Hauptmann"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.jacc.2007.02.035"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Am Coll Cardiol"
                        "fecha" => "2007"
                        "volumen" => "49"
                        "paginaInicial" => "1490"
                        "paginaFinal" => "1495"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17397680"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            20 => array:3 [
              "identificador" => "bib0105"
              "etiqueta" => "21"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Cardioembolic stroke in aatrial fibrillation &#8211; rationale for preventive closure of the left atrial appendage"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "B&#46; Leith&#228;user"
                            1 => "J&#46;W&#46; Park"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.4070/kcj.2009.39.11.443"
                      "Revista" => array:6 [
                        "tituloSerie" => "Korean Circ J"
                        "fecha" => "2009"
                        "volumen" => "39"
                        "paginaInicial" => "443"
                        "paginaFinal" => "458"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19997539"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            21 => array:3 [
              "identificador" => "bib0110"
              "etiqueta" => "22"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Success of surgical left atrial appendage closure &#8211; assessment by transesophageal echocardiography"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "A&#46;S&#46; Kanderian"
                            1 => "A&#46;M&#46; Gillinov"
                            2 => "G&#46;B&#46; Petterson"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.jacc.2008.03.067"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Am Coll Cardiol"
                        "fecha" => "2008"
                        "volumen" => "52"
                        "paginaInicial" => "924"
                        "paginaFinal" => "929"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18772063"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            22 => array:3 [
              "identificador" => "bib0115"
              "etiqueta" => "23"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Left Atrial Appemdage Occlusion Study &#40;LAAOS&#41;&#58; results of a randomized controlled pilot study of left atrial appendage occlusion during coronary bypass surgery in patients at risk for stroke"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "J&#46;S&#46; Healey"
                            1 => "E&#46; Crystal"
                            2 => "A&#46; Lamy"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.ahj.2004.09.054"
                      "Revista" => array:6 [
                        "tituloSerie" => "Am Heart J"
                        "fecha" => "2005"
                        "volumen" => "150"
                        "paginaInicial" => "288"
                        "paginaFinal" => "293"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16086933"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            23 => array:3 [
              "identificador" => "bib0120"
              "etiqueta" => "24"
              "referencia" => array:1 [
                0 => array:1 [
                  "referenciaCompleta" => "Thoracoscopic epicardial radiofrequency ablation for atrial fibrillation&#46; NICE interventional procedures guidance 286&#46; Available from&#58; <a class="elsevierStyleInterRef" href="http://www.nice.org.uk/IPG286">www&#46;nice&#46;org&#46;uk&#47;IPG286</a> &#91;accessed 15&#46;06&#46;10&#93;"
                ]
              ]
            ]
            24 => array:3 [
              "identificador" => "bib0125"
              "etiqueta" => "25"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "ACC&#47;AHA 2006 guidelines for the management of patients with valvular heart disease&#58; executive summary"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "R&#46;O&#46; Bonow"
                            1 => "B&#46;A&#46; Carabello"
                            2 => "K&#46; Chatterjee"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Circulation"
                        "fecha" => "2006"
                        "volumen" => "114"
                        "paginaInicial" => "450"
                        "paginaFinal" => "527"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            25 => array:3 [
              "identificador" => "bib0130"
              "etiqueta" => "26"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Feasibility of closed-chest ligation of the left atrial appendage in humans"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "K&#46; Bartus"
                            1 => "J&#46; Bednarek"
                            2 => "J&#46; Myc"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.hrthm.2010.10.040"
                      "Revista" => array:6 [
                        "tituloSerie" => "Heart Rhythm"
                        "fecha" => "2011"
                        "volumen" => "8"
                        "paginaInicial" => "188"
                        "paginaFinal" => "193"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21050893"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            26 => array:3 [
              "identificador" => "bib0135"
              "etiqueta" => "27"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Percutaneous left atrial appendage transcatheter occlusion to prevent stroke in high-risk patients with atrial fibrillation&#58; early clinical experience"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "H&#46; Sievert"
                            1 => "M&#46;D&#46; Lesh"
                            2 => "T&#46; Trepels"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Circulation"
                        "fecha" => "2002"
                        "volumen" => "105"
                        "paginaInicial" => "1887"
                        "paginaFinal" => "1889"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11997272"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            27 => array:3 [
              "identificador" => "bib0140"
              "etiqueta" => "28"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Percutaneous left atrial appendage transcatheter occlusion &#40;PLAATO system&#41; to prevent stroke in high-risk patients with non-rheumatic atrial fibrillation&#58; results from the international multi-center feasibility trials"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "S&#46;H&#46; Ostermayer"
                            1 => "M&#46; Reisman"
                            2 => "P&#46;H&#46; Kramer"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.jacc.2005.03.042"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Am Coll Cardiol"
                        "fecha" => "2005"
                        "volumen" => "46"
                        "paginaInicial" => "9"
                        "paginaFinal" => "14"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15992628"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            28 => array:3 [
              "identificador" => "bib0145"
              "etiqueta" => "29"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Percutaneous left atrial appendage transcatheter occlusion &#40;PLAATO&#41; for stroke prevention in atrial fibrillation&#58; 2-year outcomes"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "J&#46;W&#46; Park"
                            1 => "B&#46; Leith&#228;user"
                            2 => "U&#46; Gerk"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "J Invasive Cardiol"
                        "fecha" => "2009"
                        "volumen" => "21"
                        "paginaInicial" => "446"
                        "paginaFinal" => "450"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19726815"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            29 => array:3 [
              "identificador" => "bib0150"
              "etiqueta" => "30"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Percutaneous left atrial appendage occlusion for patients with atrial fibrillation suboptimal for warfarin therapy&#58; 5-year results of the PLAATO &#40;Percutaneous Left Atrial Appendage Transcatheter Occlusion&#41; study"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "P&#46;C&#46; Block"
                            1 => "S&#46; Burstein"
                            2 => "P&#46;N&#46; Casale"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.jcin.2009.05.005"
                      "Revista" => array:6 [
                        "tituloSerie" => "JACC Cardiovasc Interv"
                        "fecha" => "2009"
                        "volumen" => "2"
                        "paginaInicial" => "594"
                        "paginaFinal" => "600"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19628179"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            30 => array:3 [
              "identificador" => "bib0155"
              "etiqueta" => "31"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Transcatheter left atrial appendage occlusion with Amplatzer devices to obviate anticoagulation in patients with atrial fibrillation"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "B&#46; Meier"
                            1 => "I&#46; Palacios"
                            2 => "S&#46; Windecker"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1002/ccd.10660"
                      "Revista" => array:6 [
                        "tituloSerie" => "Catheter Cardiovasc Interv"
                        "fecha" => "2003"
                        "volumen" => "60"
                        "paginaInicial" => "417"
                        "paginaFinal" => "422"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/14571497"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            31 => array:3 [
              "identificador" => "bib0160"
              "etiqueta" => "32"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Left atrial appendage closure with Amplatzer cardiac plug in atrial fibrillation&#58; initial European experience"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "J&#46;W&#46; Park"
                            1 => "A&#46; Bethencourt"
                            2 => "H&#46; Sievert"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1002/ccd.22764"
                      "Revista" => array:6 [
                        "tituloSerie" => "Catheter Cardiovasc Interv"
                        "fecha" => "2011"
                        "volumen" => "77"
                        "paginaInicial" => "700"
                        "paginaFinal" => "706"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20824765"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            32 => array:3 [
              "identificador" => "bib0165"
              "etiqueta" => "33"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Thrombus formation after left atrial appendage exclusion using an Amplatzer cardiac plug device"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "I&#46; Cruz-Gonzalez"
                            1 => "J&#46; Mart&#237;n Moreiras"
                            2 => "E&#46; Garc&#237;a"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1002/ccd.23126"
                      "Revista" => array:6 [
                        "tituloSerie" => "Catheter Cardiovasc Interv"
                        "fecha" => "2011"
                        "volumen" => "78"
                        "paginaInicial" => "970"
                        "paginaFinal" => "973"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21523900"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            33 => array:3 [
              "identificador" => "bib0170"
              "etiqueta" => "34"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Thrombus formation on a left atrial appendage closure device"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "L&#46; Cardona"
                            1 => "G&#46; Ana"
                            2 => "B&#46; Lu&#237;sa"
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                      ]
                    ]
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                  "host" => array:1 [
                    0 => array:2 [
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                      "Revista" => array:6 [
                        "tituloSerie" => "Circulation"
                        "fecha" => "2011"
                        "volumen" => "124"
                        "paginaInicial" => "1595"
                        "paginaFinal" => "1596"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21969319"
                            "web" => "Medline"
                          ]
                        ]
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                    ]
                  ]
                ]
              ]
            ]
            34 => array:3 [
              "identificador" => "bib0175"
              "etiqueta" => "35"
              "referencia" => array:1 [
                0 => array:1 [
                  "referenciaCompleta" => "Available from&#58; <a class="elsevierStyleInterRef" href="http://www.mhra.gov.uk/home/groups/fsn/documents/fieldsafetynotice/con108673.pdf">www&#46;mhra&#46;gov&#46;uk&#47;home&#47;groups&#47;fsn&#47;documents&#47;fieldsafetynotice&#47;con108673&#46;pdf</a> &#91;accessed 21&#46;02&#46;12&#93;"
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              ]
            ]
            35 => array:3 [
              "identificador" => "bib0180"
              "etiqueta" => "36"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Thrombus formation on the new amplatzer cardiac plug after LAA olccusion &#8211; a word of caution"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
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                            1 => "P&#46; Kahlert"
                            2 => "H&#46; K&#228;lsch"
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                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:3 [
                        "tituloSerie" => "Clin Res Cardiol"
                        "fecha" => "2011"
                        "volumen" => "100"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            36 => array:3 [
              "identificador" => "bib0185"
              "etiqueta" => "37"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Left atrial appendage closure with the Amplatzer cardiac plug in patients with atrial fibrillation"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "E&#46;E&#46; Gu&#233;rios"
                            1 => "M&#46; Schmid"
                            2 => "S&#46; Gloekler"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Arq Bras Cardiol"
                        "fecha" => "2012"
                        "volumen" => "98"
                        "paginaInicial" => "528"
                        "paginaFinal" => "536"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22584492"
                            "web" => "Medline"
                          ]
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                      ]
                    ]
                  ]
                ]
              ]
            ]
            37 => array:3 [
              "identificador" => "bib0190"
              "etiqueta" => "38"
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Article information

ISSN: 21742049
Original language: English

DOI:10.1016/j.repce.2012.06.006

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Year/Month	Html	Pdf	Total

2024 November	13	5	18
2024 October	50	31	81
2024 September	46	27	73
2024 August	51	30	81
2024 July	48	31	79
2024 June	37	16	53
2024 May	38	25	63
2024 April	48	23	71
2024 March	61	18	79
2024 February	55	29	84
2024 January	24	32	56
2023 December	21	29	50
2023 November	29	23	52
2023 October	15	18	33
2023 September	18	19	37
2023 August	23	22	45
2023 July	19	7	26
2023 June	27	11	38
2023 May	40	25	65
2023 April	20	8	28
2023 March	38	23	61
2023 February	38	22	60
2023 January	28	13	41
2022 December	42	23	65
2022 November	69	30	99
2022 October	21	15	36
2022 September	44	51	95
2022 August	41	43	84
2022 July	39	34	73
2022 June	23	23	46
2022 May	22	27	49
2022 April	18	22	40
2022 March	21	27	48
2022 February	24	33	57
2022 January	16	19	35
2021 December	21	25	46
2021 November	31	32	63
2021 October	31	38	69
2021 September	23	24	47
2021 August	40	31	71
2021 July	16	32	48
2021 June	20	16	36
2021 May	23	42	65
2021 April	34	39	73
2021 March	35	15	50
2021 February	42	11	53
2021 January	37	15	52
2020 December	21	9	30
2020 November	41	15	56
2020 October	25	16	41
2020 September	42	14	56
2020 August	22	8	30
2020 July	43	7	50
2020 June	34	7	41
2020 May	41	5	46
2020 April	35	9	44
2020 March	43	8	51
2020 February	77	12	89
2020 January	40	8	48
2019 December	45	6	51
2019 November	25	9	34
2019 October	40	4	44
2019 September	46	15	61
2019 August	33	9	42
2019 July	38	12	50
2019 June	33	5	38
2019 May	47	10	57
2019 April	38	15	53
2019 March	141	10	151
2019 February	121	12	133
2019 January	138	5	143
2018 December	135	14	149
2018 November	102	1	103
2018 October	182	18	200
2018 September	38	15	53
2018 August	37	8	45
2018 July	20	4	24
2018 June	36	7	43
2018 May	52	7	59
2018 April	44	2	46
2018 March	40	8	48
2018 February	48	4	52
2018 January	37	5	42
2017 December	78	3	81
2017 November	62	10	72
2017 October	51	8	59
2017 September	45	11	56
2017 August	37	8	45
2017 July	36	3	39
2017 June	41	18	59
2017 May	53	12	65
2017 April	29	17	46
2017 March	69	23	92
2017 February	124	9	133
2017 January	44	2	46
2016 December	50	18	68
2016 November	60	7	67
2016 October	65	9	74
2016 September	48	10	58
2016 August	20	1	21
2016 July	23	9	32
2016 June	5	10	15
2016 May	9	2	11
2016 April	49	2	51
2016 March	89	11	100
2016 February	111	26	137
2016 January	78	16	94
2015 December	92	10	102
2015 November	90	9	99
2015 October	82	14	96
2015 September	95	15	110
2015 August	85	16	101
2015 July	64	8	72
2015 June	36	4	40
2015 May	41	6	47
2015 April	76	14	90
2015 March	78	4	82
2015 February	79	8	87
2015 January	65	12	77
2014 December	71	13	84
2014 November	65	10	75
2014 October	84	14	98
2014 September	68	11	79
2014 August	74	9	83
2014 July	75	12	87
2014 June	69	11	80
2014 May	74	20	94
2014 April	61	13	74
2014 March	92	18	110
2014 February	86	11	97
2014 January	104	21	125
2013 December	81	17	98
2013 November	99	27	126
2013 October	69	12	81
2013 September	92	19	111
2013 August	107	27	134
2013 July	95	22	117
2013 June	24	13	37

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