1 CLINICAL RESEARCH EuroIntervention 2014;10-online publish-ahead-of-print July 2014 DOI: 10.4244/EIJY14M07_03 © Europa Digital & Publishing 2014. All rights reserved. *Corresponding author: Bern University Hospital, 3010 Bern, Switzerland. E-mail: bernhard.meier@insel.ch Double device left atrial appendage closure Ênio E. Guérios 1,2 , MD; Steffen Gloekler 1 , MD; Michael Schmid 1 , MD; Ahmed Khattab 1 , MD; Fabian Nietlispach 1 , MD; Bernhard Meier 1 *, MD 1. Department of Cardiology, Bern University Hospital, Bern, Switzerland; 2. Concept - Centro de Cardiopatias Congênitas e Estruturais do Paraná, Curitiba, Brazil Abstract Aims: Percutaneous left atrial appendage (LAA) occlusion is an alternative to oral anticoagulation for the prevention of stroke in patients with non-valvular atrial fibrillation (NVAF). Due to the great anatomic vari- ability of the LAA, complete closure may not always be obtained with a single device. We report cases in which adequate closure of the LAA was achieved with implantation of 2 devices. Methods and results: Five out of 223 consecutive patients who underwent LAA occlusion without guid- ance with transoesophageal echocardiography (TOE) had a second device implanted to treat significant resid- ual leaks or uncovered parts of the LAA after first device implantation. All procedures were successful, with no complications. Two patients received two AMPLATZER Cardiac Plugs (ACP); one patient received one ACP and one AMPLATZER Vascular Plug; one patient received one AMPLATZER Septal Occluder (ASO) and one ACP prototype; and one patient received two ASOs. TOE performed at least four months after the procedure showed complete closure of the LAA in all patients, without thrombus formation on the devices. After 14 patient-years there were no strokes, peripheral thromboemboli, or device embolisations. Conclusions: When necessary, the implantation of two devices to achieve complete LAA occlusion in patients with NVAF is feasible and leads to favourable results during follow-up. Potentially, this technical innovation may widen LAA occlusion indications by permitting occlusion of LAAs with large ostia or com- plex anatomy. KEYWORDS • atrial fibrillation • closure devices • left atrial appendage SUBMITTED ON 11/03/2013 - REVISION RECEIVED ON 15/08/2013 - ACCEPTED ON 04/09/2013