Abstract
BACKGROUND: Percutaneous left atrial appendage (LAA) closure (LAAC) is a proven stroke prevention strategy for patients with atrial fibrillation (AF). However, incomplete sealing in complex LAA anatomies may compromise efficacy. OBJECTIVES: This study evaluates the safety, feasibility, and efficacy of concomitant dual-device LAAC in multilobed anatomies, representing the largest cohort examined to date. METHODS: We reviewed all LAAC procedures performed at the University Hospital of Bern between 2009 and 2025. Baseline characteristics, procedural details, and follow-up data were analyzed for patients receiving dual-device LAAC. Endpoints included technical success, complications, thromboembolic events, and device-related issues. Continuous data were expressed as mean ± standard deviation or median values, while categorical data were reported as percentages. Group comparisons were conducted using t-test, Mann-Whitney U test, or chi-square test. Differences were expressed as 95% confidence intervals, and a p-value of less than 0.05 was considered significant. RESULTS: Of 1,307 LAAC procedures, 10 included dual-device implantation. The mean age of the patients was 71 years, and all patients were men. The Congestive heart failure, Hypertension, Age ≥75 years, Diabetes mellitus, prior Stroke or TIA, Vascular disease, Age 65-74 years, Sex category (CHA(2)DS(2)-VASc) and Hypertension, Abnormal renal/liver function, Stroke, Bleeding history or predisposition, Labile INR, Elderly, Drugs/alcohol (HAS-BLED) scores were 3.5 ± 1.8 and 2.9 ± 1.4, respectively. Most patients (70%) had paroxysmal AF. Preprocedural and intraprocedural transesophageal echocardiography (TEE) confirmed multilobed LAA anatomy in all cases. Half of the procedures were fluoroscopy-guided with one delivery sheath and transseptal puncture, while the other half were TEE-guided with a double sheath and two transseptal punctures. Only Amplatzer devices were used: Eight procedures employed two devices of the same type [five Amulet, three Amplatzer Cardiac Plug (ACP)], and two procedures combined different types (Amulet + ACP, ACP + Amplatzer Vascular Plug). Technical success was achieved in all cases. Within the first week, one (10%) patient experienced a clinically non-clinically relevant pericardial effusion. At 1-year follow-up (completed in nine patients), three (30%) patients developed pericarditis. No thromboembolic events, device-related thrombosis, or device embolization occurred. CONCLUSION: In this small cohort of patients with complex multilobed LAA anatomy, concomitant implantation of two Amplatzer devices proved to be a feasible strategy with acceptable short-term safety, although potentially associated with an increased risk of pericarditis.