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Background: Percutaneous left atrial appendage (LAA) occlusion is a novel approach for stroke propyhaxis in patients with atrial fibrillation and contraindications for oral anticoagulation. The Amplatzer Cardiac Plug (ACP) consists of a lobe anchored in the LAA with a connected disk shielding the LAA ostium. We observed 6 cases with thrombus formation on the device. We analyzed pre interventional echocardiographic parameters to identify potential risk factors.Methods: LAA occlusion was performed in 34 patients (CHADS2 score ≥2) with the ACP under concious sedation. Post interventional dual antiplatelet therapy was initiated according to manufacturer's instructions of use. Transthoracic (TTE) and transesophageal echo (TEE) were performed pre interventionally as well as pre discharge, 3 and 6 months TEE follow ups. Pre procedural ejection fraction (EF), left atrial volume index (LAVi), LAA velocity, spontaneous echo contrast (SEC, scored 0 to 4) and transmitral gradient (TMG) were analyzed.Results: In 36 procedures 34 ACP were implanted successfully. 2 ACP could not be placed due to an inappropriate anatomy. Mean occluder size was 24.1 ± 3.1 mm. In 3 patients thrombus was detected in the pre discharge TEE, in 3 further patients after 3 months. Mean EF was 50.6 ± 11.4 % in the non-thrombus vs. 39.7 ± 10.6 % in the thrombus group (p = 0.039, significant). LAVi was 46.9 ± 20.8 vs. 56.6 ±14.2 ml/m2 (p = 0.285), LAA velocity was 51.3 ± 25.1 vs. 36.8 ± 17.7 cm/s (p = 0.194), SEC was 1.3 ± 0.9 vs. 1.5 ± 0.5 (p = 0.632) and TMG was 1.9 ±2.0 vs. 1.4 ± 0.5 mmHg (p = 0.568).Conclusions: Thrombus formation on the ACP device is a serious complication. The EF was significantly lower in the thrombus group and could be therefore identified as a potential risk factor under the current antiplatelet regime.