Percutaneous closure of the left atrial appendage for prevention of thromboembolism in atrial fibrillation for patients with contraindication to or failure of oral anticoagulation: A single-center experience | Revista Portuguesa de Cardiologia (English edition)

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Image courtesy of Boston Scientific, Plymouth, MN. Reproduced by permission." ] ] ] "textoCompleto" => "IntroductionAtrial fibrillation (AF) is a 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>AF is associated with high morbidity and mortality due to its thromboembolic potential; it doubles the risk of death independently of other factors and increases the risk of stroke five-fold compared to individuals of the same age 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, are often fatal or severely disabling, and are more likely to recur.<a class="elsevierStyleCrossRefs" href="#bib0010">2–6</a>The thromboembolic potential is similar for all forms of AF, including paroxysmal.<a class="elsevierStyleCrossRefs" href="#bib0005">1–3</a> The method for assessment of stroke risk in AF recommended by the European Society of Cardiology is the CHADS2 score, which is based on a point system in which 2 points are assigned for a history of stroke or transient ischemic attack (TIA) and 1 point each is assigned for age >75 years, a history of hypertension, diabetes, or recent cardiac failure. A CHADS2 score ≥2 corresponds to a stroke risk of ≥4%/year and is an indication for oral anticoagulation (OAC). For a CHADS2 score of 0 or 1 the decision on whether to institute OAC should be reassessed considering ‘clinically relevant non-major’ risk factors using the CHA2DS2-VASc score, which assigns 2 points for a history of stroke or TIA, or age ≥75; and 1 point each for age 65–74 years, a history of hypertension, diabetes, recent cardiac failure, vascular disease (myocardial infarction, complex aortic plaque, and peripheral arterial disease), and female gender. OAC is indicated for a CHA2DS2-VASc score of ≥2 (annual stroke risk ≥2.2%).<a class="elsevierStyleCrossRef" href="#bib0010">2</a>Antithrombotic therapy has been shown to reduce mortality and stroke in AF.<a class="elsevierStyleCrossRef" href="#bib0010">2</a> Warfarin is the first line treatment for thromboembolic prevention, reducing relative risk of stroke by 60–73% for an international normalized ratio (INR) of 2–3,<a class="elsevierStyleCrossRefs" href="#bib0010">2–9</a> clearly superior to aspirin, which achieved a reduction of only 20%.<a class="elsevierStyleCrossRefs" href="#bib0010">2,7</a> There are concerns over bleeding complications with warfarin use, the most feared of which is intracranial bleeding, for which the risk rises for INR over 3.5.<a class="elsevierStyleCrossRefs" href="#bib0010">2–7</a> Assessment of the individual patient's bleeding risk is thus an essential step in the decision to prescribe anticoagulation, and for this the ESC guidelines recommend the HAS-BLED score (hypertension, abnormal renal/liver function, stroke, bleeding history or predisposition, labile INR, elderly (>65), drugs/alcohol concomitantly), in which a score of ≥3 indicates ‘high risk’, and some caution and regular monitoring of the patient is needed following the initiation of antithrombotic therapy.<a class="elsevierStyleCrossRef" href="#bib0010">2</a>However, warfarin is contraindicated in 14–44% of AF patients at risk of stroke.<a class="elsevierStyleCrossRef" href="#bib0050">10</a> Even among eligible patients, only 54% are anticoagulated, for a variety of reasons, including the need for frequent laboratory testing and for the patient's cooperation, and clinicians’ wariness.<a class="elsevierStyleCrossRefs" href="#bib0020">4,5</a> Furthermore, anticoagulated patients present INR values within the therapeutic window in only 50–68% of tests.<a class="elsevierStyleCrossRef" href="#bib0045">9</a>These obstacles to warfarin therapy have led to a search for alternatives for thromboembolic prevention in AF. The new anticoagulants are divided into 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> Dabigatran (the RE-LY study<a class="elsevierStyleCrossRef" href="#bib0055">11</a>), rivaroxaban (ROCKETAF<a class="elsevierStyleCrossRef" href="#bib0060">12</a>) and apixaban (ARISTOTLE<a class="elsevierStyleCrossRef" href="#bib0065">13</a>) have demonstrated non-inferiority to warfarin in thromboembolic prevention in AF, and the first two have been approved by the US Food and Drug Administration (FDA) for this purpose.<a class="elsevierStyleCrossRef" href="#bib0070">14</a> The latest guidelines for the management of atrial fibrillation of the European Society of Cardiology consider dabigatran an alternative to warfarin in AF patients with indication for OAC.<a class="elsevierStyleCrossRef" href="#bib0010">2</a> The latest Canadian Cardiovascular Society guidelines also recommend the use of dabigatran rather than warfarin in these patients.<a class="elsevierStyleCrossRef" href="#bib0050">10</a>However, these drugs are expensive for chronic therapy, carry a significant bleeding risk, 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="#bib0065">13</a> but higher than seen for warfarin in the RE-LY<a class="elsevierStyleCrossRef" href="#bib0055">11</a> (21% for dabigatran vs. 17%) and ROCKET-AF<a class="elsevierStyleCrossRef" href="#bib0060">12</a> (23.7% for rivaroxaban vs. 22.2%) trials.At the same time, all these drugs are contraindicated in patients with a history of hemorrhagic stroke, which, when taken together with their high thromboembolic risk, constitutes a dilemma in terms of stroke prevention.The left atrial appendage (LAA) has been identified by autopsy studies, transesophageal echocardiography (TEE) and direct intraoperative inspection as the most common site of intracardiac thrombi in AF, accounting for 58% of sites in valvular AF and 90–98% in non-valvular AF.<a class="elsevierStyleCrossRefs" href="#bib0075">15–19</a>In the light of these facts, percutaneous closure of the LAA was seen as an alternative to pharmacological anticoagulation to prevent thromboembolism in AF. Three different types of device have been developed for percutaneous LAA closure, the feasibility of which has been demonstrated in numerous trials.<a class="elsevierStyleCrossRefs" href="#bib0020">4,5,9,19,20</a>The PLAATO (Percutaneous Left Atrial Appendage Transcatheter Occlusion) system (ev3 Inc., Plymouth, MN)<a class="elsevierStyleCrossRef" href="#bib0105">21</a> was the first device to be designed and used for percutaneous LAA closure. 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, and three rows of anchors to attach the device to the LAA orifice. Several series were published confirming the feasibility and efficacy of this device for thromboembolic prevention in AF, but reports of infrequent but serious complications led to the manufacturer withdrawing the device from the market.<a class="elsevierStyleCrossRefs" href="#bib0095">19,21</a>The second device developed for LAA closure is the Amplatzer Cardiac Plug (ACP) (St. Jude Medical, Plymouth, MN),<a class="elsevierStyleCrossRef" href="#bib0110">22</a> with a self-expanding nitinol 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="#fig0005">Figure 1</a>). It is available in eight lobe sizes from 16 to 30 mm at 2-mm intervals.<a class="elsevierStyleCrossRef" href="#bib0110">22</a> Its feasibility and safety have been demonstrated in various series, all of which showed a stroke/TIA rate lower than that expected on the basis of the CHADS2 score. After the procedure, patients in these series were medicated with clopidogrel for 1–3 months and aspirin for three months or indefinitely. However, concerns subsequently surfaced about thrombus formation on the device, prompting the manufacturer to issue a Field Safety Notice updating the instructions for use and recommending aspirin for six months post-implant, leaving the decision to continue this regimen thereafter at the discretion of the physician, and recommending clopidogrel or an alternate antiplatelet, with prescription following routine standard of care.<a class="elsevierStyleCrossRef" href="#bib0095">19</a><elsevierMultimedia ident="fig0005"></elsevierMultimedia>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 OAC.38The Watchman device<a class="elsevierStyleCrossRef" href="#bib0045">9</a> (Boston Scientific, Plymouth, MN) was also 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="#fig0010">Figure 2</a>). It is available in five diameters from 21 to 33 mm at 3-mm intervals.<a class="elsevierStyleCrossRef" href="#bib0045">9</a> Its feasibility and safety have also been demonstrated. Initial post-procedural medication specified warfarin for 45 days and aspirin indefinitely, which was later modified to include clopidogrel between 45 days and the six-month follow-up.<a class="elsevierStyleCrossRef" href="#bib0095">19</a> The non-inferiority of percutaneous LAA closure with the Watchman device compared to warfarin was established by the randomized PROTECT AF trial,<a class="elsevierStyleCrossRefs" href="#bib0040">8,19</a> which included patients with non-valvular AF and CHADS2 score of ≥1. As more patients underwent treatment with this device and with a longer follow-up in the CAP registry,<a class="elsevierStyleCrossRef" href="#bib0115">23</a> fears concerning the safety of the technique began to recede; it became clear that the complications were largely procedure-related, decreased in frequency with greater operator experience, and led to less significant disability than those related to warfarin therapy, which accumulate linearly over time.<a class="elsevierStyleCrossRefs" href="#bib0095">19,23</a><elsevierMultimedia ident="fig0010"></elsevierMultimedia>The invasive nature of percutaneous LAA closure means that in theory the best risk/benefit ratio will be in patients with greater thromboembolic risk and contraindication to anticoagulation therapy. However, the PROTECT AF trial<a class="elsevierStyleCrossRef" href="#bib0040">8</a> included patients with CHADS2 score of ≥1, and the applicability of its results to those at higher risk is questionable. Furthermore, patients in that trial were medicated with warfarin for 45 days after the procedure, which also limits its applicability to those with contraindication to OAC.Reports of percutaneous LAA closure combined with antiplatelet therapy (aspirin with or without clopidogrel, both for varying periods) with no initial period of anticoagulation post-implantation have been published in series on the PLAATO device (which detected a low rate of thromboembolic events),<a class="elsevierStyleCrossRef" href="#bib0095">19</a> on the ACP device (which reported some cases of device-related thrombi),<a class="elsevierStyleCrossRef" href="#bib0095">19</a> and on the Watchman device in the ASA Plavix Feasibility Study With WATCHMAN Left Atrial Appendage Closure Technology (ASAP) prospective non-randomized registry.<a class="elsevierStyleCrossRef" href="#bib0120">24</a> The latter included 150 patients with non-valvular AF, CHADS2 score of ≥1 and contraindication to warfarin who took clopidogrel for six months and aspirin indefinitely; the authors concluded that implantation of the Watchman was safe and effective without temporary warfarin therapy.<a class="elsevierStyleCrossRef" href="#bib0125">25</a>The aim of the present study was to evaluate the initial experience of a single center in percutaneous LAA closure in patients with high thromboembolic risk and in whom OAC was impractical or contraindicated or had failed, between May 2010 and June 2012.MethodsPatient selectionBetween May 2010 and June 2012, 23 patients with non-valvular AF of any type (permanent, persistent or paroxysmal) and high thromboembolic risk (CHADS2 score ≥2), in whom OAC was impractical or contraindicated or had failed, were selected for percutaneous LAA closure in our center.OAC was considered impractical when medication with vitamin K antagonists was not an option, due to labile INR or inability to monitor INR.Contraindication to OAC was defined as the presence of a history of cerebral bleeding, major bleeding under OAC or antiplatelet therapy, or bleeding dyscrasia. Anticoagulation therapy was considered to have failed when an embolic event had occurred and a thrombus had been detected in the LAA despite anticoagulation with warfarin and therapeutic INR levels.A CHADS2 score ≥2 was chosen as an inclusion criterion because this is the level of risk at which thromboembolic prevention with OAC is indicated. Since it was intended to include patients in whom warfarin therapy was impractical, it was considered that this criterion would select those who in theory would benefit most from the nonpharmacological alternative under analysis.Exclusion criteria were the presence of congenital heart disease, valve disease, known or suspected hypercoagulable state, pregnancy, allergy to nickel, active endocarditis or possible source of bacteremia, mechanical prosthetic valve, pacemaker leads or implantable cardioverter-defibrillator in the cardiac chambers, intracardiac thrombus, or an LAA too small for percutaneous closure using the available devices.In order to assess the latter two criteria, TEE was performed in all patients before the procedure to measure the LAA orifice and to exclude thrombi, particularly in the LAA.Device implantation and follow-up protocolSelected patients were admitted the day before the procedure and medicated with dual antiplatelet therapy (DAT) (aspirin 100 mg i.d. and clopidogrel 75 mg i.d.), subcutaneous enoxaparin 1 mg/kg/h every 12 hours (except for the last dose prior to the procedure), and saline infusion 1 ml/kg/h begun 12 hours before the procedure and continued for 24 hours afterwards to prevent contrast nephropathy and to maintain intravascular and LAA volume. Cefuroxime 750 mg was administered intravenously one hour before the procedure for bacterial endocarditis prophylaxis.All procedures were performed under deep sedation or general anesthesia with an anesthetist in attendance. Access was via a femoral route and implantation was guided by fluoroscopy and TEE. During the procedure an intravenous heparin bolus was administered to achieve partial activated thromboplastin time of ≥250 s.Two types of closure device were used, the ACP and the Watchman. All were implanted by the same operator.TEE was performed under deep sedation or general anesthesia at 0°, 45°, 90° and 135° to confirm the absence of thrombi in the LAA, and to measure its depth and the widest diameter of its orifice (<a class="elsevierStyleCrossRef" href="#fig0015">Figure 3</a>).<elsevierMultimedia ident="fig0015"></elsevierMultimedia>Transseptal puncture was guided by fluoroscopy and TEE and a superstiff guidewire was inserted, through which a multipurpose catheter was advanced to the LAA, followed by two contrast injections (right anterior oblique [RAO] 20°, caudal 20° and RAO 20°, cranial 20°), to fill the LAA for measuring purposes.The ACP was the first device to be used at our center, the Watchman only being used more recently.The device size was selected according to echocardiographic and angiographic measurements of the LAA in order to ensure that the lobe of the ACP was 2 mm wider than the LAA orifice (requiring an orifice diameter of 12.6–28.5 mm and a landing zone of ≥10 mm) and that the Watchman device was 10–20% wider than the orifice diameter, which had to be between 16.8 and 30.4 mm.The ACP was prepared by flushing with saline to expel air bubbles from inside the device during its insertion into the delivery catheter.The device was implanted in the LAA and its position and stability assessed by echocardiography and fluoroscopy. The ACP was considered to be correctly positioned if two-thirds of the lobe was distal to the circumflex artery on TEE and showed a degree of compression of the lobe by the LAA. Successful implantation was defined as absence of significant blush on fluoroscopy and peri-device flow of <3 mm on TEE, in accordance with the classification proposed by Ostermayer et al.<a class="elsevierStyleCrossRef" href="#bib0130">26</a>The position of the Watchman device was assessed using the PASS criteria: position – the device should be distal to or at the LAA orifice; anchor – the stability of the device should be tested under fluoroscopic monitoring: the anchors should be engaged and the device should be stable; if it moves to a site showing a lesser degree of pressure or apposition, it should be repositioned; size – the device should be compressed by 8–20% of its original size, as measured by TEE after positioning; seal – the device should span the orifice so that there is no peri-device flow.When the positioning criteria were satisfied, the device was released and fluoroscopic and echocardiographic assessment was repeated (<a class="elsevierStyleCrossRef" href="#fig0020">Figure 4</a>) to identify possible immediate complications such as device dislodgement or migration, formation of intracardiac or device thrombus, pericardial effusion, compression of the circumflex artery or left superior pulmonary vein, or presence of residual flow. If the criteria were not met, the device was completely or partially recaptured and repositioned before being released.<elsevierMultimedia ident="fig0020"></elsevierMultimedia>Following the procedure, patients were medicated with DAT (aspirin 100 mg i.d. and clopidogrel 75 mg i.d.) for one month and single antiplatelet therapy indefinitely. DAT was chosen as a result of the inclusion criteria adopted, since in most patients OAC was contraindicated or impractical. The duration of therapy for each antiplatelet agent was determined on the basis of previous studies on the ACP device<a class="elsevierStyleCrossRef" href="#bib0095">19</a>; the Watchman devices were implanted before the results of the ASAP trial<a class="elsevierStyleCrossRef" href="#bib0125">25</a> were known.Patients remained in hospital under clinical surveillance for up to 24 hours after the procedure to monitor for access-related complications, bleeding, and hemodynamic stability. Transthoracic echocardiography was performed a day after the procedure to rule out pericardial effusion, device dislodgement or migration, peri-device flow and thrombi adhering to the device.One month after closure patients underwent TEE to assess for signs of incomplete endothelialization (peri-device flow of ≥3 mm), thrombus adhering to the device, device dislodgement or migration, or signs of compression of the circumflex artery or left superior pulmonary vein. If no complications were detected, DAT was replaced by a single antiplatelet; if signs of incomplete endothelialization were detected DAT was continued, while thrombus formation was treated by anticoagulation therapy.Follow-up was maintained with transthoracic echocardiographic assessment at three, six and nine months and TEE at 12 months to screen once again for local complications.Clinical monitoring was maintained at the same time as echocardiographic assessment and as required and adverse events were recorded, including death, stroke/TIA, or need for surgery due to periprocedural or device-related complications.Statistical analysisA descriptive analysis was performed of quantitative variables, expressed as means and standard deviation, and of categorical variables, which were expressed as absolute and relative frequencies.Relative frequencies are expressed as percentages rounded to one decimal place. The statistical analysis was performed using SPSS version 17.ResultsPopulation characteristicsPercutaneous LAA closure was successful in 22 of the 23 patients initially selected.Mean CHADS2 score was 3.2±0.9, mean CHA2DS2-VASC score was 4.7±1.4, and mean HAS-BLED score was 3.7±1.3 (≥3 in 81.8% of cases). AFA was permanent in 72.7%, persistent in 13.6% and paroxysmal in 13.6% of patients.The characteristics of the study population are presented in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>.<elsevierMultimedia ident="tbl0005"></elsevierMultimedia>Twelve patients (54.5%) were selected on the basis of contraindication to OAC, due to acquired sideroblastic anemia (n=1; 4.5%), history of cerebral hemorrhage (n=2; 9.1%; one case of spontaneous bleeding under OAC and another following craniocerebral trauma), severe bleeding under warfarin therapy (n=6; 27.3%), and severe bleeding under single antiplatelet therapy (n=3; 13.6%). In eight patients (36.4%) OAC was not an option due to labile INR (n=4; 18.2%) or to difficulties in monitoring INR and high thrombotic and bleeding risk (n=4; 18.2%). Another two patients (9.1%) were selected following failure of OAC therapy, after suffering ischemic stroke with therapeutic INR and detection of LAA thrombus.Procedural successLAA closure was unsuccessful in only one of the 23 selected patients, due to the presence of diffuse venous disease that ruled out vascular access. The overall success rate was therefore 95.7%.The first device selected was successfully implanted in all cases except one (95.4%), in which the device was initially oversized and was replaced, without complications. The final result of all implantations was satisfactory on the basis of the criteria used, as documented by color Doppler TEE and contrast fluoroscopy immediately after implantation.The ACP device was used in 20 patients (90.9%), while the Watchman device was used in two more recent procedures.<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a> shows the characteristics of the LAA, devices and procedures.<elsevierMultimedia ident="tbl0010"></elsevierMultimedia>Procedural complicationsDuring the first 24 hours after the procedure there were two cases of oropharyngeal bleeding related to intubation, resolved within a few hours by local hemostatic measures, and three puncture site-related inguinal hematomas, one complicated by a femoral artery pseudoaneurysm, all resolved by minimally invasive measures. One case of mild pericardial effusion was also detected on transthoracic echocardiography, which resolved spontaneously. The main complications are summarized in <a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>.<elsevierMultimedia ident="tbl0015"></elsevierMultimedia>No other periprocedural complications were observed, including device dislodgement or embolization, stroke/TIA, death, need for surgery due to periprocedural or device-related complications, or severe bleeding with need for transfusion.MedicationAfter the procedure, most patients followed the proposed therapeutic regimen of DAT for one month followed by single antiplatelet therapy indefinitely. This was changed in four patients due to complications. One did not take antiplatelet drugs due to a history of severe bleeding under single antiplatelet therapy as well as under OAC, associated with a major periprocedural vascular complication (femoral artery pseudoaneurysm and significant hematoma at the puncture site). The two patients with history of embolic stroke and documented LAA thrombus under warfarin therapy at therapeutic INR levels were prescribed DAT for one month combined with dabigatran 110 mg 2 i.d., and thereafter continued OAC. In another patient DAT was replaced after one month by subcutaneous enoxaparin 1 mg/kg every 12 hours when a thrombus was detected adhering to the device. Anticoagulation with enoxaparin was continued for five months until the thrombus resolved, at which point single antiplatelet therapy was begun (since this patient had a history of severe bleeding under OAC with therapeutic INR).Complications during follow-upControl TEE one month after the procedure identified a thrombus on the atrial face of the ACP in one patient; DAT was replaced by enoxaparin 1 mg/kg every 12 hours and stricter echocardiographic control was instituted, with assessments at one week (which documented a slight regression of the thrombus), then monthly up to six months post-procedure, when the thrombus had almost completely resolved. Given the patient's history of severe bleeding under OAC with therapeutic INR, single antiplatelet therapy was begun. Thrombophilia and immunological tests were negative. Three months later the patient presented subacute anemia without evident blood loss; investigation revealed colon cancer, which was treated by surgery and chemotherapy. No thrombus was visible on TEE 12 months after LAA closure.Only one case of peri-device flow was identified, which according to the classification of Ostermayer et al.<a class="elsevierStyleCrossRef" href="#bib0130">26</a> was mild (color jet width <3 mm), detected on one-month follow-up TEE following implantation of a Watchman device.During a mean follow-up of 12±8 months, there were no deaths or other complications or thromboembolic events.DiscussionThe data presented demonstrate the feasibility of percutaneous LAA closure, which was successful in almost all patients in whom it was attempted; the only failure was due to difficulty in vascular access rather than problems with the implantation technique. Our success rate is similar to those of the main published series on percutaneous LAA closure (<a class="elsevierStyleCrossRef" href="#tbl0020">Table 4</a>).<a class="elsevierStyleCrossRef" href="#bib0095">19</a><elsevierMultimedia ident="tbl0020"></elsevierMultimedia>Our recent experience with the Watchman shows that the availability of a second device will bring advantages in terms of a wider range of sizes and different conformations and technical aspects, making it easier to select the device that is best adapted to each patient's anatomy.With regard to the safety of the technique, the only complications observed in our series were mild and resolved either spontaneously or after minimally invasive measures and without functional repercussions.The most commonly reported complication in percutaneous LAA closure is severe pericardial effusion with hemodynamic compromise requiring pericardiocentesis, but this was not seen in our series; nor were other reported complications such as device dislodgement or migration, need for surgery, or procedure-related death (<a class="elsevierStyleCrossRef" href="#tbl0020">Table 4</a>).<a class="elsevierStyleCrossRef" href="#bib0095">19</a>The most serious complication in our series was device thrombus, which may have been due to a subsequently diagnosed paraneoplastic syndrome. There is no agreement concerning the best antithrombotic protocol to adopt in these patients, since OAC was contraindicated or impractical in most of them, unlike the population of the PROTECT AF trial, all of whom underwent warfarin therapy for 45 days after LAA closure. However, we consider that our treatment protocol and follow-up were appropriate, since the thrombotic complication mentioned above was identified rapidly, enabling treatment to be adjusted accordingly.Although the patients in this study had high bleeding risk, with a mean HAS-BLED of 3.7±1.3 (≥3 in 81.8% of patients), no severe bleeding occurred, either periprocedurally or during follow-up. We therefore consider that the antiplatelet therapy implemented was adequate.Most of the complications observed occurred in patients implanted with the ACP device, but this was to expected given that this was used in 90.1% of cases.The only case of peri-device flow was mild according to Ostermayer et al.’s classification.<a class="elsevierStyleCrossRef" href="#bib0130">26</a> A recent study by Viles-Gonzalez et al.,<a class="elsevierStyleCrossRef" href="#bib0135">27</a> based on a retrospective analysis of the intervention group in PROTECT AF, showed that the incidence of peri-device flow does not increase significantly over time, nor does it increase thromboembolic risk or significantly alter prognosis. These findings were independent of severity of flow and of duration of warfarin therapy.<a class="elsevierStyleCrossRef" href="#bib0135">27</a>The series presented included patients with higher thromboembolic risk than in the main published series,<a class="elsevierStyleCrossRef" href="#bib0095">19</a> with a higher mean CHADS2 score (3.2±0.9), due to the selection criteria used. The stroke/TIA rate observed (0% in 12±8 months) was lower than that expected on the basis of the CHADS2 score (6.8±2.2%/year) and CHA2DS2-VASC score (6.4±2.5%/year), as seen in various published series.<a class="elsevierStyleCrossRef" href="#bib0095">19</a>ConclusionsIn patients with AF and high thromboembolic and bleeding risk, percutaneous LAA closure was feasible, safe and effective, with a lower stroke/TIA rate than that expected on the basis of the CHADS2 and CHA2DS2-VASC scores. This non-pharmacological treatment can therefore be considered an alternative for patients in whom OAC is impractical, contraindicated or ineffective.Ethical disclosuresProtection of human and animal subjectsThe authors declare that the procedures followed were in accordance with the regulations of the relevant clinical research ethics committee and with those of the Code of Ethics of the World Medical Association (Declaration of Helsinki).Confidentiality of dataThe authors declare that they have followed the protocols of their work center on the publication of patient data and that all the patients included in the study received sufficient information and gave their written informed consent to participate in the study.Right to privacy and informed consentThe authors have obtained the written informed consent of the patients or subjects mentioned in the article. The corresponding author is in possession of this document." "textoCompletoSecciones" => array:1 [ "secciones" => array:11 [ 0 => array:2 [ "identificador" => "xres247125" "titulo" => array:6 [ 0 => "Abstract" 1 => "Introduction" 2 => "Objective" 3 => "Methods" 4 => "Results" 5 => "Conclusions" ] ] 1 => array:2 [ "identificador" => "xpalclavsec234416" "titulo" => "Keywords" ] 2 => array:2 [ "identificador" => "xres247124" "titulo" => array:6 [ 0 => "Resumo" 1 => "Introdução" 2 => "Objetivo" 3 => "Métodos" 4 => "Resultados" 5 => "Conclusões" ] ] 3 => array:2 [ "identificador" => "xpalclavsec234415" "titulo" => "Palavras-chave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:3 [ "identificador" => "sec0010" "titulo" => "Methods" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0015" "titulo" => "Patient selection" ] 1 => array:2 [ "identificador" => "sec0020" "titulo" => "Device implantation and follow-up protocol" ] 2 => array:2 [ "identificador" => "sec0025" "titulo" => "Statistical analysis" ] ] ] 6 => array:3 [ "identificador" => "sec0030" "titulo" => "Results" "secciones" => array:5 [ 0 => array:2 [ "identificador" => "sec0035" "titulo" => "Population characteristics" ] 1 => array:2 [ "identificador" => "sec0040" "titulo" => "Procedural success" ] 2 => array:2 [ "identificador" => "sec0045" "titulo" => "Procedural complications" ] 3 => array:2 [ "identificador" => "sec0050" "titulo" => "Medication" ] 4 => array:2 [ "identificador" => "sec0055" "titulo" => "Complications during follow-up" ] ] ] 7 => array:2 [ "identificador" => "sec0060" "titulo" => "Discussion" ] 8 => array:2 [ "identificador" => "sec0065" "titulo" => "Conclusions" ] 9 => 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" ] ] ] 10 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2012-07-20" "fechaAceptado" => "2012-10-22" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec234416" "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" => "xpalclavsec234415" "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" => "IntroductionIn non-valvular atrial fibrillation 90% of thrombi originate in the left atrial appendage (LAA). Percutaneous LAA closure has been shown to be non-inferior to warfarin for prevention of thromboembolism. ObjectiveTo evaluate the initial experience of a single center in percutaneous LAA closure in patients with high thromboembolic risk and in whom oral anticoagulation was impractical or contraindicated or had failed. MethodsPatients with non-valvular atrial fibrillation and CHADS2 score ≥2 in whom oral anticoagulation was impractical or contraindicated or had failed underwent percutaneous LAA closure according to the standard technique. After the procedure, dual antiplatelet therapy was maintained for one month, followed by single antiplatelet therapy indefinitely. Patients were followed by clinical assessment and transthoracic and transesophageal echocardiography. ResultsThe procedure was performed in 22 of the 23 selected patients (95.7%), mean age 70±9 years, CHADS2 score 3.2±0.9 and CHA2DS2-VASC score 4.7±1.4. Intraprocedural device replacement was necessary only in the first patient, due to oversizing. The following periprocedural complications were observed: one femoral pseudoaneurysm, three femoral hematomas and two minor oropharyngeal bleeds, resolved by local hemostatic measures. During a 12±8 month follow-up a mild peri-device flow and a thrombus adhering to the device, resolved under with enoxaparin therapy, were identified. The rate of transient ischemic attack (TIA)/stroke was lower than expected according to the CHADS2 score (0 vs. 6.7±2.2%). ConclusionsIn our initial experience, this procedure proved to be a feasible, safe and effective alternative for atrial fibrillation patients in whom oral anticoagulation is not an option. Only relatively minor complications were observed, with a lower than expected TIA/stroke rate." ] "pt" => array:2 [ "titulo" => "Resumo" "resumen" => "IntroduçãoNa fibrilhação auricular não valvular, 90% dos trombos originam-se no apêndice auricular esquerdo. O seu encerramento percutâneo mostrou ser não inferior à varfarina na profilaxia do tromboembolismo. ObjetivoAvaliar a experiência inicial de um centro no encerramento percutâneo do apêndice auricular esquerdo em doentes com elevado risco tromboembólico sem possibilidade, com contraindicação ou falência da anticoagulação oral. MétodosDoentes com fibrilhação auricular não valvular, score CHADS2 ≥ 2 sem possibilidade, com contraindicação ou falência da anticoagulação oral foram submetidos a encerramento percutâneo do apêndice auricular esquerdo de acordo com a técnica padrão. Após implantação, foi mantida dupla antiagregação durante um mês e simples indefinidamente. Realizado seguimento com avaliação clínica, ecocardiografia transtorácica e transesofágica. ResultadosO procedimento foi conseguido em 22 dos 23 doentes selecionados (95,7%): 70±9 anos, score CHADS2 de 3,2±0,9 e CHA2DS2-VASC de 4,7±1,4. Apenas no primeiro doente o dispositivo foi substituído por sobredimensionamento. Foram observadas as seguintes complicações periprocedimento: um pseudoaneurisma femoral, 3 hematomas femorais e 2 hemorragias da orofaringe, resolvidos com medidas locais. Durante o seguimento de 12±8 meses foram identificados um fluxo peridispositivo ligeiro e um trombo aderente ao dispositivo - que resolveu sob enoxaparina. A taxa de AVC/AIT foi inferior à esperada com base no score CHADS2 (0 versus 6,7±2,2%). ConclusõesNa nossa experiência inicial este procedimento mostrou ser uma alternativa exequível, segura e eficaz em doentes com fibrilhação auricular para os quais a anticoagulação oral não é uma opção. Foram identificadas complicações de baixa severidade, com uma taxa de AVC/AIT inferior à esperada." ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "Please cite this article as: Faustino, A, et al. Encerramento percutâneo do apêndice auricular esquerdo paraprofilaxia de tromboembolismo na fibrilhação auricular em doentes com contraindicação ou falência da hipocoagulação oral: experiência de um serviço. Rev Port Cardiol 2013. http://dx.doi.org/10.1016/j.repc.2012.10.011." ] ] "multimedia" => array:8 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1268 "Ancho" => 2772 "Tamanyo" => 332268 ] ] "descripcion" => array:1 [ "en" => "Amplatzer Cardiac Plug (St. Jude Medical, Plymouth, MN). Image courtesy of St. Jude Medical, Plymouth, MN. Reproduced by permission." ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 965 "Ancho" => 2938 "Tamanyo" => 242418 ] ] "descripcion" => array:1 [ "en" => "Watchman (Boston Scientific, Plymouth, MN). Image courtesy of Boston Scientific, Plymouth, MN. Reproduced by permission." ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 1353 "Ancho" => 2932 "Tamanyo" => 251562 ] ] "descripcion" => array:1 [ "en" => "Assessment of left atrial appendage before implantation of closure device by transesophageal echocardiography, mid-esophageal view at 95° (A) and by contrast fluoroscopy in right anterior oblique view (B)." ] ] 3 => array:7 [ "identificador" => "fig0020" "etiqueta" => "Figure 4" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr4.jpeg" "Alto" => 1347 "Ancho" => 2935 "Tamanyo" => 260387 ] ] "descripcion" => array:1 [ "en" => "Assessment of left atrial appendage after implantation of closure device by color Doppler transesophageal echocardiography in mid-esophageal view at 42° (A) and by contrast fluoroscopy in anteroposterior view (B)." ] ] 4 => array:7 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:2 [ "leyenda" => "AF: atrial fibrillation; CHADS2 risk: stroke/TIA risk/year expected on the basis of CHADS2 score; CHA2DS2-VASC risk: stroke/TIA risk/year expected on the basis of CHA2DS2-VASC 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=""><tbody title="tbody"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="2" align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Characteristics</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">Age (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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">70±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">Male, 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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">15 (68.2) \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">Type of AF, 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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \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">Paroxysmal \t\t\t\t\t\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">3 (13.6) \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">Persistent \t\t\t\t\t\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">3 (13.6) \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">Permanent \t\t\t\t\t\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 (72.7) \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">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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3.2±0.9 \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">CHADS2risk (%/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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">6.7±2.2 \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">CHA2DS2-VASC score \t\t\t\t\t\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">4.7±1.4 \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">CHA2DS2-VASC risk (%/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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">6.2±2.7 \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">HAS-BLED score \t\t\t\t\t\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">3.7±1.3 \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">HAS-BLED score ≥3, 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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">18 (81.8) \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab352993.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Characteristics of the study population." ] ] 5 => array:7 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:2 [ "leyenda" => "ACP: Amplatzer Cardiac Plug; LAA: left atrial appendage; TEE: transesophageal echocardiography." "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=""><tbody title="tbody"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">LAA</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">LAA area by TEE (cm2) \t\t\t\t\t\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">4.7±1.2 \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">LAA depth by TEE (mm) \t\t\t\t\t\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">32.6±8.3 \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="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">LAA orifice diameter (mm)</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">Measured by 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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">20.4±2.9 \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">Measured by fluoroscopy \t\t\t\t\t\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">20.7±2.7 \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 " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">LAA lobes, n (%)</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">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">10 (45.4) \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">≥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">12 (54.5) \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">Spontaneous echo contrast grade ≥3 in LAA, 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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5 (22.7) \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">LAA hypocontractility, 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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">12 (54.5) \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="2" 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="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Devices and procedures</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">Patients selected, 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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">23 (100) \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">Patients implanted, 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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">22 (95.7) \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 " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Implantation success, n (%)</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">On 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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">22 (100) \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">On fluoroscopy \t\t\t\t\t\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">22 (100) \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="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Device type, n (%)</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">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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">20 (90.1) \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 " 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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 (9.1) \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="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Device size (mm)</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">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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">22.8±2.3 \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">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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">25.5±2.1 \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 " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Device replacement, 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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 (4.5) \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab352994.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Characteristics of the LAA, devices and procedures." ] ] 6 => array:7 [ "identificador" => "tbl0015" "etiqueta" => "Table 3" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "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">Complication \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">n (%) \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">Device implanted \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">When detected \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">Mild pericardial effusion \t\t\t\t\t\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">1 (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">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">Periprocedural \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">Inguinal hematoma \t\t\t\t\t\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">3 (13.6) \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">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">Periprocedural \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">Femoral artery pseudoaneurysm \t\t\t\t\t\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">1 (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">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">Periprocedural \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">Oropharyngeal bleeding \t\t\t\t\t\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">2 (9.1) \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">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">Periprocedural \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 (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">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">At one month \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab352991.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Complications in the periprocedural period and during follow-up." ] ] 7 => array:7 [ "identificador" => "tbl0020" "etiqueta" => "Table 4" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:2 [ "leyenda" => "a TTE criteria – flow velocity in the LAA <20 cm/s or moderate or dense spontaneous echocardiographic contrast. b Requiring treatment (pericardiocentesis or surgery). 1st gen.: first-generation device; 2nd gen.: second-generation device; ACP: Amplatzer Cardiac Plug; AF: atrial fibrillation; OAC: oral anticoagulation; TEE: transesophageal echocardiography; TIA: transient ischemic attack." "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">Ostermayer et al.<a class="elsevierStyleCrossRef" href="#bib0130">26</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="#bib0105">21</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="#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">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">PLAATO \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\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">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">- Non-rheumatic AF ≥3 months duration- High TE risk (≥1 in Europe or ≥2 in N. America: CAD, CHADS2 score or TEE criteriaa)- 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">- 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">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">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">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">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">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">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">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">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">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">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">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">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 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">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">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">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">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">- Aspirin 300–325 mg i.d. indefinitely- Clopidogrel 75 mg i.d. at discretion of investigator \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\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 300–325 mg i.d. indefinitely- Clopidogrel 75 mg i.d. for 1–3 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 (81–100 mg i.d.) indefinitely- Warfarin 45 days- Later patients: clopidogrel 75 mg i.d. 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 (81–325 mg i.d.) indefinitely- Warfarin 45 days- Clopidogrel 75 mg i.d. 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 " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Duration of follow-up \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\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">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 " 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">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">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%) \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">Stroke+TIA/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="" 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="" 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="" 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="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \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">- 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">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">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 by CHADS2 score \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\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">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">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">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">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 " 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 (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">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 => "xTab352992.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Main results and complications in the principal published series on left atrial appendage closure devices." ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:28 [ 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 atrial fibrillation 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:4 [ "tituloSerie" => "Cardiol Res Pract" "fecha" => "2011" "volumen" => "2011" "paginaInicial" => "1-7" ] ] ] ] ] ] 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 randomised 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 (WATCHMAN 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" => "Canadian Cardiovascular Society atrial fibrillation guidelines 2010: prevention of stroke and systemic thromboembolism in atrial fibrillation and flutter" "autores" => array:1 [ 0 => array:3 [ "colaboracion" => "CCS Atrial Fibrillation Guidelines Committee" "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" ] ] ] ] ] ] ] ] 10 => array:3 [ "identificador" => "bib0055" "etiqueta" => "11" "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" ] ] ] ] ] ] ] ] 11 => array:3 [ "identificador" => "bib0060" "etiqueta" => "12" "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" ] ] ] ] ] ] ] ] 12 => array:3 [ "identificador" => "bib0065" "etiqueta" => "13" "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" ] ] ] ] ] ] ] ] 13 => array:3 [ "identificador" => "bib0070" "etiqueta" => "14" "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" ] ] ] ] ] ] ] ] 14 => array:3 [ "identificador" => "bib0075" "etiqueta" => "15" "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" ] ] ] ] ] ] ] ] 15 => array:3 [ "identificador" => "bib0080" "etiqueta" => "16" "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 randomised 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" ] ] ] ] ] ] ] ] 16 => array:3 [ "identificador" => "bib0085" "etiqueta" => "17" "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" ] ] ] ] ] ] ] ] 17 => array:3 [ "identificador" => "bib0090" "etiqueta" => "18" "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" ] ] ] ] ] ] ] ] 18 => array:3 [ "identificador" => "bib0095" "etiqueta" => "19" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Encerramento percutâneo do apêndice auricular esquerdo para profilaxia de tromboembolismo na fibrilhação auricular" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "A. Faustino" 1 => "L. Paiva" 2 => "R. Providência" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.repc.2012.06.017" "Revista" => array:3 [ "tituloSerie" => "Rev Port Cardiol" "fecha" => "2012" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/2631811" "web" => "Medline" ] ] ] ] ] ] ] ] 19 => array:3 [ "identificador" => "bib0100" "etiqueta" => "20" "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" ] ] ] ] ] ] ] ] 20 => array:3 [ "identificador" => "bib0105" "etiqueta" => "21" "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:1 [ "Revista" => array:5 [ "tituloSerie" => "Cathet Cardiovasc Interv" "fecha" => "2011" "volumen" => "77" "paginaInicial" => "700" "paginaFinal" => "706" ] ] ] ] ] ] 21 => array:3 [ "identificador" => "bib0110" "etiqueta" => "22" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "Amplatzer Cardiac Plug Clinical Trial (ACP). Available from: <a class="elsevierStyleInterRef" id="intr0010" href="http://www.clinicaltrials.gov/identifier">www.clinicaltrials.gov/identifier: NCT01118299</a> [accessed 21.02.12]." ] ] ] 22 => array:3 [ "identificador" => "bib0115" "etiqueta" => "23" "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" ] ] ] ] ] ] ] ] 23 => array:3 [ "identificador" => "bib0120" "etiqueta" => "24" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "ASA Plavix feasibility study with WATCHMAN left atrial appendage closure technology. Available from: <a class="elsevierStyleInterRef" id="intr0020" href="http://www.clinicaltrials.gov/identifier">www.clinicaltrials.gov/identifier: NCT00851578</a> [accessed 27.02.12]." ] ] ] 24 => array:3 [ "identificador" => "bib0125" "etiqueta" => "25" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "Reddy V, Neuzil P, Miller MA, et al. First formal analysis of the ASA Plavix Registry (ASAP): watchman left atrial appendage closure in atrial fibrillation patients with contraindication to oral anticoagulation. Heart Rhythm Society 2012 Scientific Sessions-Late breaking abstract session, Friday, May 11, 2012; Boston, MA. Abstract LB02-2. Available from: <a id="intr0030" class="elsevierStyleInterRef" href="http://www.hrsonline.org/Education-Meetings/Scientific-Sessions/Past-Scientific-Sessions%23axzz2PW5gy68R">http://www.hrsonline.org/Education-Meetings/Scientific-Sessions/Past-Scientific-Sessions#axzz2PW5gy68R</a> [accessed 04.04.13]." ] ] ] 25 => array:3 [ "identificador" => "bib0130" "etiqueta" => "26" "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" ] ] ] ] ] ] ] ] 26 => array:3 [ "identificador" => "bib0135" "etiqueta" => "27" "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. Douglas" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jacc.2011.11.028" "Revista" => array:6 [ "tituloSerie" => "J Am Coll Cardiol" "fecha" => "2012" "volumen" => "59" "paginaInicial" => "923" "paginaFinal" => "929" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22381428" "web" => "Medline" ] ] ] ] ] ] ] ] 27 => array:3 [ "identificador" => "bib0140" "etiqueta" => "28" "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" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/21742049/0000003200000006/v1_201308011249/S2174204913001050/v1_201308011249/en/main.assets" "Apartado" => array:4 [ "identificador" => "9917" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Original Articles" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/21742049/0000003200000006/v1_201308011249/S2174204913001050/v1_201308011249/en/main.pdf?idApp=UINPBA00004E&text.app=https://revportcardiol.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2174204913001050?idApp=UINPBA00004E"]

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Original article

Percutaneous closure of the left atrial appendage for prevention of thromboembolism in atrial fibrillation for patients with contraindication to or failure of oral anticoagulation: A single-center experience

Encerramento percutâneo do apêndice auricular esquerdo paraprofilaxia de tromboembolismo na fibrilhação auricular em doentes com contraindicação ou falência da hipocoagulação oral: experiência de um serviço

Ana Faustino

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anacatarina.faustino@gmail.com

Corresponding author.

, Luís Paiva, Rui Providência, Joana Trigo, Ana Botelho, Marco Costa, António Leitão-Marques

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

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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Atrial fibrillation &#40;AF&#41; is a 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><p id="par0010" class="elsevierStylePara elsevierViewall">AF is associated with high morbidity and mortality due to its thromboembolic potential&#59; it doubles the risk of death independently of other factors and increases the risk of stroke five-fold compared to individuals of the same age 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&#44; are often fatal or severely disabling&#44; and are more likely to recur&#46;<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2&#8211;6</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">The thromboembolic potential is similar for all forms of AF&#44; including paroxysmal&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#8211;3</span></a> The method for assessment of stroke risk in AF recommended by the European Society of Cardiology is the CHADS<span class="elsevierStyleInf">2</span> score&#44; which is based on a point system in which 2 points are assigned for a history of stroke or transient ischemic attack &#40;TIA&#41; and 1 point each is assigned for age &#62;75 years&#44; a history of hypertension&#44; diabetes&#44; or recent cardiac failure&#46; A CHADS<span class="elsevierStyleInf">2</span> score &#8805;2 corresponds to a stroke risk of &#8805;4&#37;&#47;year and is an indication for oral anticoagulation &#40;OAC&#41;&#46; For a CHADS<span class="elsevierStyleInf">2</span> score of 0 or 1 the decision on whether to institute OAC should be reassessed considering &#8216;clinically relevant non-major&#8217; risk factors using the CHA<span class="elsevierStyleInf">2</span>DS<span class="elsevierStyleInf">2</span>-VASc score&#44; which assigns 2 points for a history of stroke or TIA&#44; or age &#8805;75&#59; and 1 point each for age 65&#8211;74 years&#44; a history of hypertension&#44; diabetes&#44; recent cardiac failure&#44; vascular disease &#40;myocardial infarction&#44; complex aortic plaque&#44; and peripheral arterial disease&#41;&#44; and female gender&#46; OAC is indicated for a CHA<span class="elsevierStyleInf">2</span>DS<span class="elsevierStyleInf">2</span>-VASc score of &#8805;2 &#40;annual stroke risk &#8805;2&#46;2&#37;&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">Antithrombotic therapy has been shown to reduce mortality and stroke in AF&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> Warfarin is the first line treatment for thromboembolic prevention&#44; reducing relative risk of stroke by 60&#8211;73&#37; for an international normalized ratio &#40;INR&#41; of 2&#8211;3&#44;<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2&#8211;9</span></a> clearly superior to aspirin&#44; which achieved a reduction of only 20&#37;&#46;<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2&#44;7</span></a> There are concerns over bleeding complications with warfarin use&#44; the most feared of which is intracranial bleeding&#44; for which the risk rises for INR over 3&#46;5&#46;<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2&#8211;7</span></a> Assessment of the individual patient&#39;s bleeding risk is thus an essential step in the decision to prescribe anticoagulation&#44; and for this the ESC guidelines recommend the HAS-BLED score &#40;hypertension&#44; abnormal renal&#47;liver function&#44; stroke&#44; bleeding history or predisposition&#44; labile INR&#44; elderly &#40;&#62;65&#41;&#44; drugs&#47;alcohol concomitantly&#41;&#44; in which a score of &#8805;3 indicates &#8216;high risk&#8217;&#44; and some caution and regular monitoring of the patient is needed following the initiation of antithrombotic therapy&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">However&#44; warfarin is contraindicated in 14&#8211;44&#37; of AF patients at risk of stroke&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> Even among eligible patients&#44; only 54&#37; are anticoagulated&#44; for a variety of reasons&#44; including the need for frequent laboratory testing and for the patient&#39;s cooperation&#44; and clinicians&#8217; wariness&#46;<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4&#44;5</span></a> Furthermore&#44; anticoagulated patients present INR values 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><p id="par0030" class="elsevierStylePara elsevierViewall">These obstacles to warfarin therapy have led to a search for alternatives for thromboembolic prevention in AF&#46; The new anticoagulants are divided into 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> Dabigatran &#40;the RE-LY study<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a>&#41;&#44; rivaroxaban &#40;ROCKETAF<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a>&#41; and apixaban &#40;ARISTOTLE<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a>&#41; have demonstrated non-inferiority to warfarin in thromboembolic prevention in AF&#44; and the first two have been approved by the US Food and Drug Administration &#40;FDA&#41; for this purpose&#46;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a> The latest guidelines for the management of atrial fibrillation of the European Society of Cardiology consider dabigatran an alternative to warfarin in AF patients with indication for OAC&#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 these patients&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">However&#44; these drugs are expensive for chronic therapy&#44; carry a significant bleeding risk&#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="#bib0065"><span class="elsevierStyleSup">13</span></a> but higher than seen for warfarin in the RE-LY<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a> &#40;21&#37; for dabigatran vs&#46; 17&#37;&#41; and ROCKET-AF<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a> &#40;23&#46;7&#37; for rivaroxaban vs&#46; 22&#46;2&#37;&#41; trials&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">At the same time&#44; all these drugs are contraindicated in patients with a history of hemorrhagic stroke&#44; which&#44; when taken together with their high thromboembolic risk&#44; constitutes a dilemma in terms of stroke prevention&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">The left atrial appendage &#40;LAA&#41; has been identified by autopsy studies&#44; transesophageal echocardiography &#40;TEE&#41; and direct intraoperative inspection as the most common site of intracardiac thrombi in AF&#44; accounting for 58&#37; of sites in valvular AF and 90&#8211;98&#37; in non-valvular AF&#46;<a class="elsevierStyleCrossRefs" href="#bib0075"><span class="elsevierStyleSup">15&#8211;19</span></a></p><p id="par0055" class="elsevierStylePara elsevierViewall">In the light of these facts&#44; percutaneous closure of the LAA was seen as an alternative to pharmacological anticoagulation to prevent thromboembolism in AF&#46; Three different types of device have been developed for percutaneous LAA closure&#44; the feasibility of which has been demonstrated in numerous trials&#46;<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4&#44;5&#44;9&#44;19&#44;20</span></a></p><p id="par0060" class="elsevierStylePara elsevierViewall">The PLAATO &#40;Percutaneous Left Atrial Appendage Transcatheter Occlusion&#41; system &#40;ev3 Inc&#46;&#44; Plymouth&#44; MN&#41;<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">21</span></a> was the first device to be designed and used for percutaneous LAA closure&#46; 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&#44; and three rows of anchors to attach the device to the LAA orifice&#46; Several series were published confirming the feasibility and efficacy of this device for thromboembolic prevention in AF&#44; but reports of infrequent but serious complications led to the manufacturer withdrawing the device from the market&#46;<a class="elsevierStyleCrossRefs" href="#bib0095"><span class="elsevierStyleSup">19&#44;21</span></a></p><p id="par0065" class="elsevierStylePara elsevierViewall">The second device developed for LAA closure is the Amplatzer Cardiac Plug &#40;ACP&#41; &#40;St&#46; Jude Medical&#44; Plymouth&#44; MN&#41;&#44;<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">22</span></a> with a self-expanding nitinol 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="#fig0005">Figure 1</a>&#41;&#46; It is available in eight lobe sizes from 16 to 30 mm at 2-mm intervals&#46;<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">22</span></a> Its feasibility and safety have been demonstrated in various series&#44; all of which showed a stroke&#47;TIA rate lower than that expected on the basis of the CHADS<span class="elsevierStyleInf">2</span> score&#46; After the procedure&#44; patients in these series were medicated with clopidogrel for 1&#8211;3 months and aspirin for three months or indefinitely&#46; However&#44; concerns subsequently surfaced about thrombus formation on the device&#44; prompting the manufacturer to issue a Field Safety Notice updating the instructions for use and recommending aspirin for six months post-implant&#44; leaving the decision to continue this regimen thereafter 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="#bib0095"><span class="elsevierStyleSup">19</span></a></p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0070" 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 OAC&#46;<span class="elsevierStyleSup">38</span></p><p id="par0075" class="elsevierStylePara elsevierViewall">The Watchman device<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> &#40;Boston Scientific&#44; Plymouth&#44; MN&#41; was also 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="#fig0010">Figure 2</a>&#41;&#46; It is available in five diameters from 21 to 33 mm at 3-mm intervals&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> Its feasibility and safety have also been demonstrated&#46; Initial post-procedural medication specified warfarin for 45 days and aspirin indefinitely&#44; which was later modified to include clopidogrel between 45 days and the six-month follow-up&#46;<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">19</span></a> The non-inferiority of percutaneous LAA closure with the Watchman device compared to warfarin was established by the randomized PROTECT AF trial&#44;<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">8&#44;19</span></a> which included patients with non-valvular AF and CHADS<span class="elsevierStyleInf">2</span> score of &#8805;1&#46; As more patients underwent treatment with this device and with a longer follow-up in the CAP registry&#44;<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">23</span></a> fears concerning the safety of the technique began to recede&#59; it became clear that the complications were largely procedure-related&#44; decreased in frequency with greater operator experience&#44; and led to less significant disability than those related to warfarin therapy&#44; which accumulate linearly over time&#46;<a class="elsevierStyleCrossRefs" href="#bib0095"><span class="elsevierStyleSup">19&#44;23</span></a></p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0080" class="elsevierStylePara elsevierViewall">The invasive nature of percutaneous LAA closure means that in theory the best risk&#47;benefit ratio will be in patients with greater thromboembolic risk and contraindication to anticoagulation therapy&#46; However&#44; the PROTECT AF trial<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> included patients with CHADS<span class="elsevierStyleInf">2</span> score of &#8805;1&#44; and the applicability of its results to those at higher risk is questionable&#46; Furthermore&#44; patients in that trial were medicated with warfarin for 45 days after the procedure&#44; which also limits its applicability to those with contraindication to OAC&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">Reports of percutaneous LAA closure combined with antiplatelet therapy &#40;aspirin with or without clopidogrel&#44; both for varying periods&#41; with no initial period of anticoagulation post-implantation have been published in series on the PLAATO device &#40;which detected a low rate of thromboembolic events&#41;&#44;<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">19</span></a> on the ACP device &#40;which reported some cases of device-related thrombi&#41;&#44;<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">19</span></a> and on the Watchman device in the ASA Plavix Feasibility Study With WATCHMAN Left Atrial Appendage Closure Technology &#40;ASAP&#41; prospective non-randomized registry&#46;<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">24</span></a> The latter included 150 patients with non-valvular AF&#44; CHADS<span class="elsevierStyleInf">2</span> score of &#8805;1 and contraindication to warfarin who took clopidogrel for six months and aspirin indefinitely&#59; the authors concluded that implantation of the Watchman was safe and effective without temporary warfarin therapy&#46;<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">25</span></a></p><p id="par0090" class="elsevierStylePara elsevierViewall">The aim of the present study was to evaluate the initial experience of a single center in percutaneous LAA closure in patients with high thromboembolic risk and in whom OAC was impractical or contraindicated or had failed&#44; between May 2010 and June 2012&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Methods</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Patient selection</span><p id="par0095" class="elsevierStylePara elsevierViewall">Between May 2010 and June 2012&#44; 23 patients with non-valvular AF of any type &#40;permanent&#44; persistent or paroxysmal&#41; and high thromboembolic risk &#40;CHADS<span class="elsevierStyleInf">2</span> score &#8805;2&#41;&#44; in whom OAC was impractical or contraindicated or had failed&#44; were selected for percutaneous LAA closure in our center&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">OAC was considered impractical when medication with vitamin K antagonists was not an option&#44; due to labile INR or inability to monitor INR&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">Contraindication to OAC was defined as the presence of a history of cerebral bleeding&#44; major bleeding under OAC or antiplatelet therapy&#44; or bleeding dyscrasia&#46; Anticoagulation therapy was considered to have failed when an embolic event had occurred and a thrombus had been detected in the LAA despite anticoagulation with warfarin and therapeutic INR levels&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">A CHADS<span class="elsevierStyleInf">2</span> score &#8805;2 was chosen as an inclusion criterion because this is the level of risk at which thromboembolic prevention with OAC is indicated&#46; Since it was intended to include patients in whom warfarin therapy was impractical&#44; it was considered that this criterion would select those who in theory would benefit most from the nonpharmacological alternative under analysis&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">Exclusion criteria were the presence of congenital heart disease&#44; valve disease&#44; known or suspected hypercoagulable state&#44; pregnancy&#44; allergy to nickel&#44; active endocarditis or possible source of bacteremia&#44; mechanical prosthetic valve&#44; pacemaker leads or implantable cardioverter-defibrillator in the cardiac chambers&#44; intracardiac thrombus&#44; or an LAA too small for percutaneous closure using the available devices&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">In order to assess the latter two criteria&#44; TEE was performed in all patients before the procedure to measure the LAA orifice and to exclude thrombi&#44; particularly in the LAA&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Device implantation and follow-up protocol</span><p id="par0125" class="elsevierStylePara elsevierViewall">Selected patients were admitted the day before the procedure and medicated with dual antiplatelet therapy &#40;DAT&#41; &#40;aspirin 100 mg i&#46;d&#46; and clopidogrel 75 mg i&#46;d&#46;&#41;&#44; subcutaneous enoxaparin 1 mg&#47;kg&#47;h every 12 hours &#40;except for the last dose prior to the procedure&#41;&#44; and saline infusion 1 ml&#47;kg&#47;h begun 12 hours before the procedure and continued for 24 hours afterwards to prevent contrast nephropathy and to maintain intravascular and LAA volume&#46; Cefuroxime 750 mg was administered intravenously one hour before the procedure for bacterial endocarditis prophylaxis&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">All procedures were performed under deep sedation or general anesthesia with an anesthetist in attendance&#46; Access was via a femoral route and implantation was guided by fluoroscopy and TEE&#46; During the procedure an intravenous heparin bolus was administered to achieve partial activated thromboplastin time of &#8805;250 s&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall">Two types of closure device were used&#44; the ACP and the Watchman&#46; All were implanted by the same operator&#46;</p><p id="par0140" class="elsevierStylePara elsevierViewall">TEE was performed under deep sedation or general anesthesia at 0&#176;&#44; 45&#176;&#44; 90&#176; and 135&#176; to confirm the absence of thrombi in the LAA&#44; and to measure its depth and the widest diameter of its orifice &#40;<a class="elsevierStyleCrossRef" href="#fig0015">Figure 3</a>&#41;&#46;</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0145" class="elsevierStylePara elsevierViewall">Transseptal puncture was guided by fluoroscopy and TEE and a superstiff guidewire was inserted&#44; through which a multipurpose catheter was advanced to the LAA&#44; followed by two contrast injections &#40;right anterior oblique &#91;RAO&#93; 20&#176;&#44; caudal 20&#176; and RAO 20&#176;&#44; cranial 20&#176;&#41;&#44; to fill the LAA for measuring purposes&#46;</p><p id="par0150" class="elsevierStylePara elsevierViewall">The ACP was the first device to be used at our center&#44; the Watchman only being used more recently&#46;</p><p id="par0155" class="elsevierStylePara elsevierViewall">The device size was selected according to echocardiographic and angiographic measurements of the LAA in order to ensure that the lobe of the ACP was 2 mm wider than the LAA orifice &#40;requiring an orifice diameter of 12&#46;6&#8211;28&#46;5 mm and a landing zone of &#8805;10 mm&#41; and that the Watchman device was 10&#8211;20&#37; wider than the orifice diameter&#44; which had to be between 16&#46;8 and 30&#46;4 mm&#46;</p><p id="par0160" class="elsevierStylePara elsevierViewall">The ACP was prepared by flushing with saline to expel air bubbles from inside the device during its insertion into the delivery catheter&#46;</p><p id="par0165" class="elsevierStylePara elsevierViewall">The device was implanted in the LAA and its position and stability assessed by echocardiography and fluoroscopy&#46; The ACP was considered to be correctly positioned if two-thirds of the lobe was distal to the circumflex artery on TEE and showed a degree of compression of the lobe by the LAA&#46; Successful implantation was defined as absence of significant blush on fluoroscopy and peri-device flow of &#60;3 mm on TEE&#44; in accordance with the classification proposed by Ostermayer et al&#46;<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">26</span></a></p><p id="par0170" class="elsevierStylePara elsevierViewall">The position of the Watchman device was assessed using the PASS criteria&#58; position &#8211; the device should be distal to or at the LAA orifice&#59; anchor &#8211; the stability of the device should be tested under fluoroscopic monitoring&#58; the anchors should be engaged and the device should be stable&#59; if it moves to a site showing a lesser degree of pressure or apposition&#44; it should be repositioned&#59; size &#8211; the device should be compressed by 8&#8211;20&#37; of its original size&#44; as measured by TEE after positioning&#59; seal &#8211; the device should span the orifice so that there is no peri-device flow&#46;</p><p id="par0175" class="elsevierStylePara elsevierViewall">When the positioning criteria were satisfied&#44; the device was released and fluoroscopic and echocardiographic assessment was repeated &#40;<a class="elsevierStyleCrossRef" href="#fig0020">Figure 4</a>&#41; to identify possible immediate complications such as device dislodgement or migration&#44; formation of intracardiac or device thrombus&#44; pericardial effusion&#44; compression of the circumflex artery or left superior pulmonary vein&#44; or presence of residual flow&#46; If the criteria were not met&#44; the device was completely or partially recaptured and repositioned before being released&#46;</p><elsevierMultimedia ident="fig0020"></elsevierMultimedia><p id="par0180" class="elsevierStylePara elsevierViewall">Following the procedure&#44; patients were medicated with DAT &#40;aspirin 100 mg i&#46;d&#46; and clopidogrel 75 mg i&#46;d&#46;&#41; for one month and single antiplatelet therapy indefinitely&#46; DAT was chosen as a result of the inclusion criteria adopted&#44; since in most patients OAC was contraindicated or impractical&#46; The duration of therapy for each antiplatelet agent was determined on the basis of previous studies on the ACP device<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">19</span></a>&#59; the Watchman devices were implanted before the results of the ASAP trial<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">25</span></a> were known&#46;</p><p id="par0185" class="elsevierStylePara elsevierViewall">Patients remained in hospital under clinical surveillance for up to 24 hours after the procedure to monitor for access-related complications&#44; bleeding&#44; and hemodynamic stability&#46; Transthoracic echocardiography was performed a day after the procedure to rule out pericardial effusion&#44; device dislodgement or migration&#44; peri-device flow and thrombi adhering to the device&#46;</p><p id="par0190" class="elsevierStylePara elsevierViewall">One month after closure patients underwent TEE to assess for signs of incomplete endothelialization &#40;peri-device flow of &#8805;3 mm&#41;&#44; thrombus adhering to the device&#44; device dislodgement or migration&#44; or signs of compression of the circumflex artery or left superior pulmonary vein&#46; If no complications were detected&#44; DAT was replaced by a single antiplatelet&#59; if signs of incomplete endothelialization were detected DAT was continued&#44; while thrombus formation was treated by anticoagulation therapy&#46;</p><p id="par0195" class="elsevierStylePara elsevierViewall">Follow-up was maintained with transthoracic echocardiographic assessment at three&#44; six and nine months and TEE at 12 months to screen once again for local complications&#46;</p><p id="par0200" class="elsevierStylePara elsevierViewall">Clinical monitoring was maintained at the same time as echocardiographic assessment and as required and adverse events were recorded&#44; including death&#44; stroke&#47;TIA&#44; or need for surgery due to periprocedural or device-related complications&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Statistical analysis</span><p id="par0205" class="elsevierStylePara elsevierViewall">A descriptive analysis was performed of quantitative variables&#44; expressed as means and standard deviation&#44; and of categorical variables&#44; which were expressed as absolute and relative frequencies&#46;</p><p id="par0210" class="elsevierStylePara elsevierViewall">Relative frequencies are expressed as percentages rounded to one decimal place&#46; The statistical analysis was performed using SPSS version 17&#46;</p></span></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Results</span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Population characteristics</span><p id="par0215" class="elsevierStylePara elsevierViewall">Percutaneous LAA closure was successful in 22 of the 23 patients initially selected&#46;</p><p id="par0220" class="elsevierStylePara elsevierViewall">Mean CHADS<span class="elsevierStyleInf">2</span> score was 3&#46;2&#177;0&#46;9&#44; mean CHA<span class="elsevierStyleInf">2</span>DS<span class="elsevierStyleInf">2</span>-VASC score was 4&#46;7&#177;1&#46;4&#44; and mean HAS-BLED score was 3&#46;7&#177;1&#46;3 &#40;&#8805;3 in 81&#46;8&#37; of cases&#41;&#46; AFA was permanent in 72&#46;7&#37;&#44; persistent in 13&#46;6&#37; and paroxysmal in 13&#46;6&#37; of patients&#46;</p><p id="par0225" class="elsevierStylePara elsevierViewall">The characteristics of the study population are presented in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0230" class="elsevierStylePara elsevierViewall">Twelve patients &#40;54&#46;5&#37;&#41; were selected on the basis of contraindication to OAC&#44; due to acquired sideroblastic anemia &#40;n&#61;1&#59; 4&#46;5&#37;&#41;&#44; history of cerebral hemorrhage &#40;n&#61;2&#59; 9&#46;1&#37;&#59; one case of spontaneous bleeding under OAC and another following craniocerebral trauma&#41;&#44; severe bleeding under warfarin therapy &#40;n&#61;6&#59; 27&#46;3&#37;&#41;&#44; and severe bleeding under single antiplatelet therapy &#40;n&#61;3&#59; 13&#46;6&#37;&#41;&#46; In eight patients &#40;36&#46;4&#37;&#41; OAC was not an option due to labile INR &#40;n&#61;4&#59; 18&#46;2&#37;&#41; or to difficulties in monitoring INR and high thrombotic and bleeding risk &#40;n&#61;4&#59; 18&#46;2&#37;&#41;&#46; Another two patients &#40;9&#46;1&#37;&#41; were selected following failure of OAC therapy&#44; after suffering ischemic stroke with therapeutic INR and detection of LAA thrombus&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Procedural success</span><p id="par0235" class="elsevierStylePara elsevierViewall">LAA closure was unsuccessful in only one of the 23 selected patients&#44; due to the presence of diffuse venous disease that ruled out vascular access&#46; The overall success rate was therefore 95&#46;7&#37;&#46;</p><p id="par0240" class="elsevierStylePara elsevierViewall">The first device selected was successfully implanted in all cases except one &#40;95&#46;4&#37;&#41;&#44; in which the device was initially oversized and was replaced&#44; without complications&#46; The final result of all implantations was satisfactory on the basis of the criteria used&#44; as documented by color Doppler TEE and contrast fluoroscopy immediately after implantation&#46;</p><p id="par0245" class="elsevierStylePara elsevierViewall">The ACP device was used in 20 patients &#40;90&#46;9&#37;&#41;&#44; while the Watchman device was used in two more recent procedures&#46;</p><p id="par0250" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a> shows the characteristics of the LAA&#44; devices and procedures&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Procedural complications</span><p id="par0255" class="elsevierStylePara elsevierViewall">During the first 24 hours after the procedure there were two cases of oropharyngeal bleeding related to intubation&#44; resolved within a few hours by local hemostatic measures&#44; and three puncture site-related inguinal hematomas&#44; one complicated by a femoral artery pseudoaneurysm&#44; all resolved by minimally invasive measures&#46; One case of mild pericardial effusion was also detected on transthoracic echocardiography&#44; which resolved spontaneously&#46; The main complications are summarized in <a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0260" class="elsevierStylePara elsevierViewall">No other periprocedural complications were observed&#44; including device dislodgement or embolization&#44; stroke&#47;TIA&#44; death&#44; need for surgery due to periprocedural or device-related complications&#44; or severe bleeding with need for transfusion&#46;</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Medication</span><p id="par0265" class="elsevierStylePara elsevierViewall">After the procedure&#44; most patients followed the proposed therapeutic regimen of DAT for one month followed by single antiplatelet therapy indefinitely&#46; This was changed in four patients due to complications&#46; One did not take antiplatelet drugs due to a history of severe bleeding under single antiplatelet therapy as well as under OAC&#44; associated with a major periprocedural vascular complication &#40;femoral artery pseudoaneurysm and significant hematoma at the puncture site&#41;&#46; The two patients with history of embolic stroke and documented LAA thrombus under warfarin therapy at therapeutic INR levels were prescribed DAT for one month combined with dabigatran 110 mg 2 i&#46;d&#46;&#44; and thereafter continued OAC&#46; In another patient DAT was replaced after one month by subcutaneous enoxaparin 1 mg&#47;kg every 12 hours when a thrombus was detected adhering to the device&#46; Anticoagulation with enoxaparin was continued for five months until the thrombus resolved&#44; at which point single antiplatelet therapy was begun &#40;since this patient had a history of severe bleeding under OAC with therapeutic INR&#41;&#46;</p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Complications during follow-up</span><p id="par0270" class="elsevierStylePara elsevierViewall">Control TEE one month after the procedure identified a thrombus on the atrial face of the ACP in one patient&#59; DAT was replaced by enoxaparin 1 mg&#47;kg every 12 hours and stricter echocardiographic control was instituted&#44; with assessments at one week &#40;which documented a slight regression of the thrombus&#41;&#44; then monthly up to six months post-procedure&#44; when the thrombus had almost completely resolved&#46; Given the patient&#39;s history of severe bleeding under OAC with therapeutic INR&#44; single antiplatelet therapy was begun&#46; Thrombophilia and immunological tests were negative&#46; Three months later the patient presented subacute anemia without evident blood loss&#59; investigation revealed colon cancer&#44; which was treated by surgery and chemotherapy&#46; No thrombus was visible on TEE 12 months after LAA closure&#46;</p><p id="par0275" class="elsevierStylePara elsevierViewall">Only one case of peri-device flow was identified&#44; which according to the classification of Ostermayer et al&#46;<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">26</span></a> was mild &#40;color jet width &#60;3 mm&#41;&#44; detected on one-month follow-up TEE following implantation of a Watchman device&#46;</p><p id="par0280" class="elsevierStylePara elsevierViewall">During a mean follow-up of 12&#177;8 months&#44; there were no deaths or other complications or thromboembolic events&#46;</p></span></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0130">Discussion</span><p id="par0285" class="elsevierStylePara elsevierViewall">The data presented demonstrate the feasibility of percutaneous LAA closure&#44; which was successful in almost all patients in whom it was attempted&#59; the only failure was due to difficulty in vascular access rather than problems with the implantation technique&#46; Our success rate is similar to those of the main published series on percutaneous LAA closure &#40;<a class="elsevierStyleCrossRef" href="#tbl0020">Table 4</a>&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">19</span></a></p><elsevierMultimedia ident="tbl0020"></elsevierMultimedia><p id="par0290" class="elsevierStylePara elsevierViewall">Our recent experience with the Watchman shows that the availability of a second device will bring advantages in terms of a wider range of sizes and different conformations and technical aspects&#44; making it easier to select the device that is best adapted to each patient&#39;s anatomy&#46;</p><p id="par0295" class="elsevierStylePara elsevierViewall">With regard to the safety of the technique&#44; the only complications observed in our series were mild and resolved either spontaneously or after minimally invasive measures and without functional repercussions&#46;</p><p id="par0300" class="elsevierStylePara elsevierViewall">The most commonly reported complication in percutaneous LAA closure is severe pericardial effusion with hemodynamic compromise requiring pericardiocentesis&#44; but this was not seen in our series&#59; nor were other reported complications such as device dislodgement or migration&#44; need for surgery&#44; or procedure-related death &#40;<a class="elsevierStyleCrossRef" href="#tbl0020">Table 4</a>&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">19</span></a></p><p id="par0305" class="elsevierStylePara elsevierViewall">The most serious complication in our series was device thrombus&#44; which may have been due to a subsequently diagnosed paraneoplastic syndrome&#46; There is no agreement concerning the best antithrombotic protocol to adopt in these patients&#44; since OAC was contraindicated or impractical in most of them&#44; unlike the population of the PROTECT AF trial&#44; all of whom underwent warfarin therapy for 45 days after LAA closure&#46; However&#44; we consider that our treatment protocol and follow-up were appropriate&#44; since the thrombotic complication mentioned above was identified rapidly&#44; enabling treatment to be adjusted accordingly&#46;</p><p id="par0310" class="elsevierStylePara elsevierViewall">Although the patients in this study had high bleeding risk&#44; with a mean HAS-BLED of 3&#46;7&#177;1&#46;3 &#40;&#8805;3 in 81&#46;8&#37; of patients&#41;&#44; no severe bleeding occurred&#44; either periprocedurally or during follow-up&#46; We therefore consider that the antiplatelet therapy implemented was adequate&#46;</p><p id="par0315" class="elsevierStylePara elsevierViewall">Most of the complications observed occurred in patients implanted with the ACP device&#44; but this was to expected given that this was used in 90&#46;1&#37; of cases&#46;</p><p id="par0320" class="elsevierStylePara elsevierViewall">The only case of peri-device flow was mild according to Ostermayer et al&#46;&#8217;s classification&#46;<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">26</span></a> A recent study by Viles-Gonzalez et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">27</span></a> based on a retrospective analysis of the intervention group in PROTECT AF&#44; showed that the incidence of peri-device flow does not increase significantly over time&#44; nor does it increase thromboembolic risk or significantly alter prognosis&#46; These findings were independent of severity of flow and of duration of warfarin therapy&#46;<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">27</span></a></p><p id="par0325" class="elsevierStylePara elsevierViewall">The series presented included patients with higher thromboembolic risk than in the main published series&#44;<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">19</span></a> with a higher mean CHADS<span class="elsevierStyleInf">2</span> score &#40;3&#46;2&#177;0&#46;9&#41;&#44; due to the selection criteria used&#46; The stroke&#47;TIA rate observed &#40;0&#37; in 12&#177;8 months&#41; was lower than that expected on the basis of the CHADS<span class="elsevierStyleInf">2</span> score &#40;6&#46;8&#177;2&#46;2&#37;&#47;year&#41; and CHA<span class="elsevierStyleInf">2</span>DS<span class="elsevierStyleInf">2</span>-VASC score &#40;6&#46;4&#177;2&#46;5&#37;&#47;year&#41;&#44; as seen in various published series&#46;<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">19</span></a></p></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0135">Conclusions</span><p id="par0330" class="elsevierStylePara elsevierViewall">In patients with AF and high thromboembolic and bleeding risk&#44; percutaneous LAA closure was feasible&#44; safe and effective&#44; with a lower stroke&#47;TIA rate than that expected on the basis of the CHADS<span class="elsevierStyleInf">2</span> and CHA<span class="elsevierStyleInf">2</span>DS<span class="elsevierStyleInf">2</span>-VASC scores&#46; This non-pharmacological treatment can therefore be considered an alternative for patients in whom OAC is impractical&#44; contraindicated or ineffective&#46;</p></span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0140">Ethical disclosures</span><span id="sec0075" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0145">Protection of human and animal subjects</span><p id="par0335" class="elsevierStylePara elsevierViewall">The authors declare that the procedures followed were in accordance with the regulations of the relevant clinical research ethics committee and with those of the Code of Ethics of the World Medical Association &#40;Declaration of Helsinki&#41;&#46;</p></span><span id="sec0080" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0150">Confidentiality of data</span><p id="par0340" class="elsevierStylePara elsevierViewall">The authors declare that they have followed the protocols of their work center on the publication of patient data and that all the patients included in the study received sufficient information and gave their written informed consent to participate in the study&#46;</p></span><span id="sec0085" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0155">Right to privacy and informed consent</span><p id="par0345" class="elsevierStylePara elsevierViewall">The authors have obtained the written informed consent of the patients or subjects mentioned in the article&#46; The corresponding author is in possession of this document&#46;</p></span></span></span>"
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        "resumen" => "<span class="elsevierStyleSectionTitle" id="sect0010">Introduction</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">In non-valvular atrial fibrillation 90&#37; of thrombi originate in the left atrial appendage &#40;LAA&#41;&#46; Percutaneous LAA closure has been shown to be non-inferior to warfarin for prevention of thromboembolism&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0015">Objective</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">To evaluate the initial experience of a single center in percutaneous LAA closure in patients with high thromboembolic risk and in whom oral anticoagulation was impractical or contraindicated or had failed&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0020">Methods</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Patients with non-valvular atrial fibrillation and CHADS<span class="elsevierStyleInf">2</span> score &#8805;2 in whom oral anticoagulation was impractical or contraindicated or had failed underwent percutaneous LAA closure according to the standard technique&#46; After the procedure&#44; dual antiplatelet therapy was maintained for one month&#44; followed by single antiplatelet therapy indefinitely&#46; Patients were followed by clinical assessment and transthoracic and transesophageal echocardiography&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0025">Results</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">The procedure was performed in 22 of the 23 selected patients &#40;95&#46;7&#37;&#41;&#44; mean age 70&#177;9 years&#44; CHADS<span class="elsevierStyleInf">2</span> score 3&#46;2&#177;0&#46;9 and CHA<span class="elsevierStyleInf">2</span>DS<span class="elsevierStyleInf">2</span>-VASC score 4&#46;7&#177;1&#46;4&#46; Intraprocedural device replacement was necessary only in the first patient&#44; due to oversizing&#46; The following periprocedural complications were observed&#58; one femoral pseudoaneurysm&#44; three femoral hematomas and two minor oropharyngeal bleeds&#44; resolved by local hemostatic measures&#46; During a 12&#177;8 month follow-up a mild peri-device flow and a thrombus adhering to the device&#44; resolved under with enoxaparin therapy&#44; were identified&#46; The rate of transient ischemic attack &#40;TIA&#41;&#47;stroke was lower than expected according to the CHADS<span class="elsevierStyleInf">2</span> score &#40;0 vs&#46; 6&#46;7&#177;2&#46;2&#37;&#41;&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0030">Conclusions</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">In our initial experience&#44; this procedure proved to be a feasible&#44; safe and effective alternative for atrial fibrillation patients in whom oral anticoagulation is not an option&#46; Only relatively minor complications were observed&#44; with a lower than expected TIA&#47;stroke rate&#46;</p>"
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        "resumen" => "<span class="elsevierStyleSectionTitle" id="sect0040">Introdu&#231;&#227;o</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Na fibrilha&#231;&#227;o auricular n&#227;o valvular&#44; 90&#37; dos trombos originam-se no ap&#234;ndice auricular esquerdo&#46; O seu encerramento percut&#226;neo mostrou ser n&#227;o inferior &#224; varfarina na profilaxia do tromboembolismo&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0045">Objetivo</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Avaliar a experi&#234;ncia inicial de um centro no encerramento percut&#226;neo do ap&#234;ndice auricular esquerdo em doentes com elevado risco tromboemb&#243;lico sem possibilidade&#44; com contraindica&#231;&#227;o ou fal&#234;ncia da anticoagula&#231;&#227;o oral&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0050">M&#233;todos</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Doentes com fibrilha&#231;&#227;o auricular n&#227;o valvular&#44; <span class="elsevierStyleItalic">score</span> CHADS<span class="elsevierStyleInf">2</span> &#8805; 2 sem possibilidade&#44; com contraindica&#231;&#227;o ou fal&#234;ncia da anticoagula&#231;&#227;o oral foram submetidos a encerramento percut&#226;neo do ap&#234;ndice auricular esquerdo de acordo com a t&#233;cnica padr&#227;o&#46; Ap&#243;s implanta&#231;&#227;o&#44; foi mantida dupla antiagrega&#231;&#227;o durante um m&#234;s e simples indefinidamente&#46; Realizado seguimento com avalia&#231;&#227;o cl&#237;nica&#44; ecocardiografia transtor&#225;cica e transesof&#225;gica&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0055">Resultados</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">O procedimento foi conseguido em 22 dos 23 doentes selecionados &#40;95&#44;7&#37;&#41;&#58; 70&#177;9 anos&#44; <span class="elsevierStyleItalic">score</span> CHADS<span class="elsevierStyleInf">2</span> de 3&#44;2&#177;0&#44;9 e CHA<span class="elsevierStyleInf">2</span>DS<span class="elsevierStyleInf">2</span>-VASC de 4&#44;7&#177;1&#44;4&#46; Apenas no primeiro doente o dispositivo foi substitu&#237;do por sobredimensionamento&#46; Foram observadas as seguintes complica&#231;&#245;es periprocedimento&#58; um pseudoaneurisma femoral&#44; 3 hematomas femorais e 2 hemorragias da orofaringe&#44; resolvidos com medidas locais&#46; Durante o seguimento de 12&#177;8 meses foram identificados um fluxo peridispositivo ligeiro e um trombo aderente ao dispositivo - que resolveu sob enoxaparina&#46; A taxa de AVC&#47;AIT foi inferior &#224; esperada com base no <span class="elsevierStyleItalic">score</span> CHADS<span class="elsevierStyleInf">2</span> &#40;0 versus 6&#44;7&#177;2&#44;2&#37;&#41;&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0060">Conclus&#245;es</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Na nossa experi&#234;ncia inicial este procedimento mostrou ser uma alternativa exequ&#237;vel&#44; segura e eficaz em doentes com fibrilha&#231;&#227;o auricular para os quais a anticoagula&#231;&#227;o oral n&#227;o &#233; uma op&#231;&#227;o&#46; Foram identificadas complica&#231;&#245;es de baixa severidade&#44; com uma taxa de AVC&#47;AIT inferior &#224; esperada&#46;</p>"
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        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; Faustino&#44; A&#44; et al&#46; Encerramento percut&#226;neo do ap&#234;ndice auricular esquerdo paraprofilaxia de tromboembolismo na fibrilha&#231;&#227;o auricular em doentes com contraindica&#231;&#227;o ou fal&#234;ncia da hipocoagula&#231;&#227;o oral&#58; experi&#234;ncia de um servi&#231;o&#46; Rev Port Cardiol 2013&#46; <span class="elsevierStyleInterRef" id="intr0005" href="doi:10.1016/j.repc.2012.10.011">http&#58;&#47;&#47;dx&#46;doi&#46;org&#47;10&#46;1016&#47;j&#46;repc&#46;2012&#46;10&#46;011</span>&#46;</p>"
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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"><span class="elsevierStyleHsp" style=""></span><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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#46;2&#177;0&#46;9&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><span class="elsevierStyleItalic">CHADS</span><span class="elsevierStyleInf"><span class="elsevierStyleItalic">2</span></span><span class="elsevierStyleItalic">risk &#40;&#37;&#47;year&#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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&#46;7&#177;2&#46;2&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><span class="elsevierStyleItalic">CHA</span><span class="elsevierStyleInf"><span class="elsevierStyleItalic">2</span></span><span class="elsevierStyleItalic">DS</span><span class="elsevierStyleInf"><span class="elsevierStyleItalic">2</span></span><span class="elsevierStyleItalic">-VASC 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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#46;7&#177;1&#46;4&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><span class="elsevierStyleItalic">CHA</span><span class="elsevierStyleInf"><span class="elsevierStyleItalic">2</span></span><span class="elsevierStyleItalic">DS</span><span class="elsevierStyleInf"><span class="elsevierStyleItalic">2</span></span><span class="elsevierStyleItalic">-VASC risk &#40;&#37;&#47;year&#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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&#46;2&#177;2&#46;7&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><span class="elsevierStyleItalic">HAS-BLED 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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#46;7&#177;1&#46;3&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><span class="elsevierStyleItalic">HAS-BLED score &#8805;3&#44; n &#40;&#37;&#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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">18 &#40;81&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
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                0 => "xTab352993.png"
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          "en" => "<p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">Characteristics of the study population&#46;</p>"
        ]
      ]
      5 => array:7 [
        "identificador" => "tbl0010"
        "etiqueta" => "Table 2"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "tabla" => array:2 [
          "leyenda" => "<p id="spar0090" class="elsevierStyleSimplePara elsevierViewall">ACP&#58; Amplatzer Cardiac Plug&#59; LAA&#58; left atrial appendage&#59; TEE&#58; transesophageal echocardiography&#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=""><tbody title="tbody"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">LAA</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><span class="elsevierStyleItalic">LAA area by TEE &#40;cm</span><span class="elsevierStyleSup"><span class="elsevierStyleItalic">2</span></span><span class="elsevierStyleItalic">&#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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#46;7&#177;1&#46;2&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><span class="elsevierStyleItalic">LAA depth by TEE &#40;mm&#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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">32&#46;6&#177;8&#46;3&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="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">LAA orifice diameter &#40;mm&#41;</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><span class="elsevierStyleHsp" style=""></span>Measured by 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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">20&#46;4&#177;2&#46;9&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><span class="elsevierStyleHsp" style=""></span>Measured by fluoroscopy&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">20&#46;7&#177;2&#46;7&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="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">LAA lobes&#44; n &#40;&#37;&#41;</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><span class="elsevierStyleHsp" style=""></span>1&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">10 &#40;45&#46;4&#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><span class="elsevierStyleHsp" style=""></span>&#8805;2&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">12 &#40;54&#46;5&#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><span class="elsevierStyleItalic">Spontaneous echo contrast grade &#8805;3 in LAA&#44; n &#40;&#37;&#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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5 &#40;22&#46;7&#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><span class="elsevierStyleItalic">LAA hypocontractility&#44; n &#40;&#37;&#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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">12 &#40;54&#46;5&#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="2" 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="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">Devices and procedures</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><span class="elsevierStyleItalic">Patients selected&#44; n &#40;&#37;&#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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">23 &#40;100&#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><span class="elsevierStyleItalic">Patients implanted&#44; n &#40;&#37;&#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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">22 &#40;95&#46;7&#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="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Implantation success&#44; n &#40;&#37;&#41;</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><span class="elsevierStyleHsp" style=""></span>On 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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">22 &#40;100&#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><span class="elsevierStyleHsp" style=""></span>On fluoroscopy&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">22 &#40;100&#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="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Device type&#44; n &#40;&#37;&#41;</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><span class="elsevierStyleHsp" style=""></span>ACP&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">20 &#40;90&#46;1&#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><span class="elsevierStyleHsp" style=""></span>Watchman&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">2 &#40;9&#46;1&#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="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Device size &#40;mm&#41;</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><span class="elsevierStyleHsp" style=""></span>ACP&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">22&#46;8&#177;2&#46;3&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><span class="elsevierStyleHsp" style=""></span>Watchman&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">25&#46;5&#177;2&#46;1&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><span class="elsevierStyleItalic">Device replacement&#44; n &#40;&#37;&#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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1 &#40;4&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
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        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0085" class="elsevierStyleSimplePara elsevierViewall">Characteristics of the LAA&#44; devices and procedures&#46;</p>"
        ]
      ]
      6 => array:7 [
        "identificador" => "tbl0015"
        "etiqueta" => "Table 3"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
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        "tabla" => array:1 [
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              "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">Complication&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">n &#40;&#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-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">Device implanted&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">When detected&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">Mild pericardial effusion&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">1 &#40;4&#46;5&#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">ACP&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">Periprocedural&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">Inguinal hematoma&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">3 &#40;13&#46;6&#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">ACP&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">Periprocedural&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">Femoral artery pseudoaneurysm&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">1 &#40;4&#46;5&#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">ACP&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">Periprocedural&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">Oropharyngeal bleeding&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">2 &#40;9&#46;1&#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">ACP&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">Periprocedural&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">Device thrombus&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">1 &#40;4&#46;5&#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">ACP&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">At one month&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab352991.png"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0095" class="elsevierStyleSimplePara elsevierViewall">Complications in the periprocedural period and during follow-up&#46;</p>"
        ]
      ]
      7 => array:7 [
        "identificador" => "tbl0020"
        "etiqueta" => "Table 4"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "tabla" => array:2 [
          "leyenda" => "<p id="spar0105" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleSup">a</span> TTE criteria &#8211; flow velocity in the LAA &#60;20 cm&#47;s or moderate or dense spontaneous echocardiographic contrast&#46; <span class="elsevierStyleSup">b</span> Requiring treatment &#40;pericardiocentesis or surgery&#41;&#46; 1st gen&#46;&#58; first-generation device&#59; 2nd gen&#46;&#58; second-generation device&#59; ACP&#58; Amplatzer Cardiac Plug&#59; AF&#58; atrial fibrillation&#59; OAC&#58; oral anticoagulation&#59; TEE&#58; transesophageal echocardiography&#59; TIA&#58; transient ischemic attack&#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">Ostermayer et al&#46;<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">26</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="#bib0105"><span class="elsevierStyleSup">21</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">Sick 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">Holmes et al&#46;&#40;PROTECT-AF&#41;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</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">Device</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">PLAATO&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">ACP&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">Watchman&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">Watchman&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">- 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<span class="elsevierStyleSup">a</span>&#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">- 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">2&#46;5&#177;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">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">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">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">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">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">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">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">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">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">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">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;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><span class="elsevierStyleSup">b</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">5 &#40;4&#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">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">1 &#40;0&#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">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">- Aspirin 300&#8211;325 mg i&#46;d&#46; indefinitely- Clopidogrel 75 mg i&#46;d&#46; at discretion of investigator&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 mg i&#46;d&#46; indefinitely- Clopidogrel 75 mg i&#46;d&#46; for 1&#8211;3 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;100 mg i&#46;d&#46;&#41; indefinitely- Warfarin 45 days- Later patients&#58; clopidogrel 75 mg i&#46;d&#46; 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 mg i&#46;d&#46;&#41; indefinitely- Warfarin 45 days- Clopidogrel 75 mg i&#46;d&#46; 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  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Duration of follow-up</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">10 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  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Stroke&#47;TIA&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 &#40;1&#46;8&#37;&#41;&#47;3 &#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">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;&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">Stroke&#43;TIA&#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="" 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="" 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="" 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="" 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></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">2&#46;2&#37;&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 by CHADS<span class="elsevierStyleInf">2</span> score&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">6&#46;3&#37;&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="elsevierStyleItalic">Mortality&#58;</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">6 &#40;5&#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">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  " 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;0&#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">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>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab352992.png"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0100" class="elsevierStyleSimplePara elsevierViewall">Main results and complications in the principal published series on left atrial appendage closure devices&#46;</p>"
        ]
      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "References"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0005"
          "bibliografiaReferencia" => array:28 [
            0 => array:3 [
              "identificador" => "bib0005"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    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"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "D&#46; Bonhorst"
                            1 => "M&#46; Mendes"
                            2 => "P&#46; Adrag&#227;o"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "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&#58; the Task Force for the management of atrial fibrillation of the European Society of Cardiology &#40;ESC&#41;"
                      "autores" => array:1 [
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                            0 => "A&#46;J&#46; Camm"
                            1 => "P&#46; Kirchhof"
                            2 => "G&#46;Y&#46; Lip"
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                    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"
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                ]
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              "identificador" => "bib0015"
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                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "Outcome parameters for trials in atrial fibrillation&#58; executive summary"
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                            0 => "P&#46; Kirchhof"
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                            2 => "J&#46; Bax"
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                    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"
                          ]
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                ]
              ]
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            3 => array:3 [
              "identificador" => "bib0020"
              "etiqueta" => "4"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Left atrial appendage closure in atrial fibrillation&#58; a world without anticoagulation&#63;"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "T&#46; Contractor"
                            1 => "A&#46; Khasnis"
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                      ]
                    ]
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                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:4 [
                        "tituloSerie" => "Cardiol Res Pract"
                        "fecha" => "2011"
                        "volumen" => "2011"
                        "paginaInicial" => "1-7"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            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"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "H&#46; Sievert"
                            1 => "Y&#46;L&#46; Bayard"
                          ]
                        ]
                      ]
                    ]
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                  "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"
                          ]
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                      ]
                    ]
                  ]
                ]
              ]
            ]
            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"
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                        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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            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"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "R&#46;G&#46; Hart"
                            1 => "L&#46;A&#46; Pearce"
                            2 => "M&#46;I&#46; 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"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
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            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&#58; a randomised non-inferiority trial"
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                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
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                            1 => "V&#46;Y&#46; Reddy"
                            2 => "Z&#46;G&#46; Turi"
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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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                      ]
                    ]
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                ]
              ]
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            8 => array:3 [
              "identificador" => "bib0045"
              "etiqueta" => "9"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The PROTECT AF &#40;WATCHMAN left atrial appendage system for embolic PROTECTion in patients with atrial fibrillation&#41; trial"
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                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "R&#46;B&#46; Fountain"
                            1 => "D&#46;R&#46; Holmes"
                            2 => "K&#46; Chandrasekaran"
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                      ]
                    ]
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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"
                            "web" => "Medline"
                          ]
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                    ]
                  ]
                ]
              ]
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              "identificador" => "bib0050"
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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:3 [
                          "colaboracion" => "CCS Atrial Fibrillation Guidelines Committee"
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                          "autores" => array:3 [
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                            1 => "S&#46; Connolly"
                            2 => "S&#46; McMurtry"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.cjca.2010.11.007"
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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"
                            "web" => "Medline"
                          ]
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                ]
              ]
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              "identificador" => "bib0055"
              "etiqueta" => "11"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Dabigatran versus warfarin in patients with atrial fibrillation"
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                          "autores" => array:3 [
                            0 => "S&#46;J&#46; Connolly"
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                            2 => "S&#46; Yusuf"
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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"
                            "web" => "Medline"
                          ]
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                ]
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              "identificador" => "bib0060"
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                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"
                            1 => "K&#46;W&#46; Mahaffey"
                            2 => "J&#46; Garg"
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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"
                            "web" => "Medline"
                          ]
                        ]
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                    ]
                  ]
                ]
              ]
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              "identificador" => "bib0065"
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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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                            0 => "C&#46;B&#46; Granger"
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                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1056/NEJMoa1107039"
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                        "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"
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                ]
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            13 => array:3 [
              "identificador" => "bib0070"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Stroke prevention in atrial fibrillation&#58; atrial appendage closure"
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                          "etal" => false
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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 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21225480"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    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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                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1161/01.STR.0000250166.06949.95"
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                        "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"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
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            15 => array:3 [
              "identificador" => "bib0080"
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                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 &#40;ACTIVE W&#41;&#58; a randomised controlled trial"
                      "autores" => array:1 [
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                            1 => "J&#46; Progue"
                            2 => "R&#46; Hart"
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                      ]
                    ]
                  ]
                  "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"
                          ]
                        ]
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                ]
              ]
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            16 => array:3 [
              "identificador" => "bib0085"
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                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "Appendage obliteration to reduce stroke in cardiac surgical patients with atrial fibrillation"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
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                            0 => "J&#46;L&#46; Blackshear"
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                    ]
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                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/0003-4975(95)00887-X"
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                        "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"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            17 => array:3 [
              "identificador" => "bib0090"
              "etiqueta" => "18"
              "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"
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                          "autores" => array:3 [
                            0 => "A&#46;L&#46; Klein"
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                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1056/NEJM200105103441901"
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                        "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"
                          ]
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                      ]
                    ]
                  ]
                ]
              ]
            ]
            18 => array:3 [
              "identificador" => "bib0095"
              "etiqueta" => "19"
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                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "Encerramento percut&#226;neo do ap&#234;ndice auricular esquerdo para profilaxia de tromboembolismo na fibrilha&#231;&#227;o auricular"
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                            2 => "R&#46; Provid&#234;ncia"
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                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.repc.2012.06.017"
                      "Revista" => array:3 [
                        "tituloSerie" => "Rev Port Cardiol"
                        "fecha" => "2012"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/2631811"
                            "web" => "Medline"
                          ]
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                      ]
                    ]
                  ]
                ]
              ]
            ]
            19 => array:3 [
              "identificador" => "bib0100"
              "etiqueta" => "20"
              "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"
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                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
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                            2 => "T&#46; Trepels"
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                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
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                        "tituloSerie" => "Circulation"
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                        "volumen" => "105"
                        "paginaInicial" => "1887"
                        "paginaFinal" => "1889"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11997272"
                            "web" => "Medline"
                          ]
                        ]
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                    ]
                  ]
                ]
              ]
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            20 => array:3 [
              "identificador" => "bib0105"
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              "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"
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                          "etal" => true
                          "autores" => array:3 [
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                            2 => "H&#46; Sievert"
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                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Cathet Cardiovasc Interv"
                        "fecha" => "2011"
                        "volumen" => "77"
                        "paginaInicial" => "700"
                        "paginaFinal" => "706"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            21 => array:3 [
              "identificador" => "bib0110"
              "etiqueta" => "22"
              "referencia" => array:1 [
                0 => array:1 [
                  "referenciaCompleta" => "Amplatzer Cardiac Plug Clinical Trial &#40;ACP&#41;&#46; Available from&#58; <a class="elsevierStyleInterRef" id="intr0010" href="http://www.clinicaltrials.gov/identifier">www&#46;clinicaltrials&#46;gov&#47;identifier</span>&#58; <span class="elsevierStyleInterRef" id="intr0015" href="ctgov:NCT01118299">NCT01118299</a> &#91;accessed 21&#46;02&#46;12&#93;&#46;"
                ]
              ]
            ]
            22 => array:3 [
              "identificador" => "bib0115"
              "etiqueta" => "23"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Safety of percutaneous left atrial appendage closure&#58; results from the Watchman Left Atrial Appendage System for Embolic Protection in Patients With AF &#40;PROTECT AF&#41; clinical trial and the Continued Access Registry"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "V&#46;Y&#46; Reddy"
                            1 => "D&#46; Holmes"
                            2 => "S&#46;K&#46; 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"
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                      ]
                    ]
                  ]
                ]
              ]
            ]
            23 => array:3 [
              "identificador" => "bib0120"
              "etiqueta" => "24"
              "referencia" => array:1 [
                0 => array:1 [
                  "referenciaCompleta" => "ASA Plavix feasibility study with WATCHMAN left atrial appendage closure technology&#46; Available from&#58; <a class="elsevierStyleInterRef" id="intr0020" href="http://www.clinicaltrials.gov/identifier">www&#46;clinicaltrials&#46;gov&#47;identifier</span>&#58; <span class="elsevierStyleInterRef" id="intr0025" href="ctgov:NCT00851578">NCT00851578</a> &#91;accessed 27&#46;02&#46;12&#93;&#46;"
                ]
              ]
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            24 => array:3 [
              "identificador" => "bib0125"
              "etiqueta" => "25"
              "referencia" => array:1 [
                0 => array:1 [
                  "referenciaCompleta" => "Reddy V&#44; Neuzil P&#44; Miller MA&#44; et al&#46; First formal analysis of the ASA Plavix Registry &#40;ASAP&#41;&#58; watchman left atrial appendage closure in atrial fibrillation patients with contraindication to oral anticoagulation&#46; Heart Rhythm Society 2012 Scientific Sessions-Late breaking abstract session&#44; Friday&#44; May 11&#44; 2012&#59; Boston&#44; MA&#46; Abstract LB02-2&#46; Available from&#58; <a id="intr0030" class="elsevierStyleInterRef" href="http://www.hrsonline.org/Education-Meetings/Scientific-Sessions/Past-Scientific-Sessions%23axzz2PW5gy68R">http&#58;&#47;&#47;www&#46;hrsonline&#46;org&#47;Education-Meetings&#47;Scientific-Sessions&#47;Past-Scientific-Sessions&#35;axzz2PW5gy68R</a> &#91;accessed 04&#46;04&#46;13&#93;&#46;"
                ]
              ]
            ]
            25 => array:3 [
              "identificador" => "bib0130"
              "etiqueta" => "26"
              "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"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            26 => array:3 [
              "identificador" => "bib0135"
              "etiqueta" => "27"
              "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&#58; a PROTECT AF &#40;percutaneous closure of the left atrial appendage versus warfarin therapy for prevention of stroke in patients with atrial fibrillation&#41; substudy"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "J&#46;F&#46; Viles-Gonzalez"
                            1 => "S&#46; Kar"
                            2 => "P&#46; Douglas"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.jacc.2011.11.028"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Am Coll Cardiol"
                        "fecha" => "2012"
                        "volumen" => "59"
                        "paginaInicial" => "923"
                        "paginaFinal" => "929"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22381428"
                            "web" => "Medline"
                          ]
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                      ]
                    ]
                  ]
                ]
              ]
            ]
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              "identificador" => "bib0140"
              "etiqueta" => "28"
              "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"
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Article information

ISSN: 21742049
Original language: English

DOI:10.1016/j.repce.2013.06.001

The statistics are updated each day

Year/Month	Html	Pdf	Total

2024 November	11	6	17
2024 October	45	41	86
2024 September	51	31	82
2024 August	54	42	96
2024 July	41	31	72
2024 June	24	38	62
2024 May	50	24	74
2024 April	40	38	78
2024 March	34	25	59
2024 February	36	31	67
2024 January	35	29	64
2023 December	24	39	63
2023 November	29	20	49
2023 October	26	21	47
2023 September	20	21	41
2023 August	35	16	51
2023 July	31	15	46
2023 June	29	17	46
2023 May	59	25	84
2023 April	35	8	43
2023 March	37	21	58
2023 February	30	32	62
2023 January	31	18	49
2022 December	55	21	76
2022 November	76	35	111
2022 October	45	19	64
2022 September	53	30	83
2022 August	59	30	89
2022 July	52	39	91
2022 June	39	31	70
2022 May	39	50	89
2022 April	43	22	65
2022 March	44	32	76
2022 February	22	27	49
2022 January	30	21	51
2021 December	24	31	55
2021 November	31	41	72
2021 October	29	43	72
2021 September	22	35	57
2021 August	37	35	72
2021 July	31	35	66
2021 June	25	24	49
2021 May	34	36	70
2021 April	108	49	157
2021 March	55	17	72
2021 February	56	8	64
2021 January	40	17	57
2020 December	26	14	40
2020 November	50	24	74
2020 October	19	19	38
2020 September	50	14	64
2020 August	30	8	38
2020 July	62	14	76
2020 June	42	7	49
2020 May	48	5	53
2020 April	52	20	72
2020 March	51	12	63
2020 February	148	21	169
2020 January	28	14	42
2019 December	48	16	64
2019 November	28	8	36
2019 October	36	13	49
2019 September	48	10	58
2019 August	32	6	38
2019 July	32	15	47
2019 June	28	12	40
2019 May	36	26	62
2019 April	33	18	51
2019 March	40	15	55
2019 February	47	17	64
2019 January	37	6	43
2018 December	52	12	64
2018 November	110	11	121
2018 October	368	17	385
2018 September	67	15	82
2018 August	60	8	68
2018 July	39	8	47
2018 June	43	7	50
2018 May	50	11	61
2018 April	70	4	74
2018 March	48	14	62
2018 February	52	8	60
2018 January	42	6	48
2017 December	64	6	70
2017 November	71	18	89
2017 October	69	14	83
2017 September	53	9	62
2017 August	51	11	62
2017 July	57	8	65
2017 June	58	7	65
2017 May	72	14	86
2017 April	54	13	67
2017 March	66	21	87
2017 February	60	17	77
2017 January	36	10	46
2016 December	58	10	68
2016 November	43	7	50
2016 October	54	1	55
2016 September	71	8	79
2016 August	25	1	26
2016 July	38	8	46
2016 June	20	8	28
2016 May	23	7	30
2016 April	48	1	49
2016 March	67	23	90
2016 February	100	36	136
2016 January	88	28	116
2015 December	65	16	81
2015 November	94	24	118
2015 October	97	21	118
2015 September	86	16	102
2015 August	56	15	71
2015 July	107	11	118
2015 June	46	1	47
2015 May	62	7	69
2015 April	65	25	90
2015 March	57	8	65
2015 February	74	9	83
2015 January	72	9	81
2014 December	77	12	89
2014 November	76	18	94
2014 October	88	14	102
2014 September	55	8	63
2014 August	67	9	76
2014 July	82	13	95
2014 June	73	14	87
2014 May	75	10	85
2014 April	69	18	87
2014 March	80	23	103
2014 February	83	27	110
2014 January	94	21	115
2013 December	94	19	113
2013 November	109	15	124
2013 October	79	18	97
2013 September	99	28	127
2013 August	89	39	128

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