Percutaneous left atrial appendage suture ligation using the LARIAT device in patients with atrial fibrillation: initial clinical experience.
OBJECTIVE
The purpose of the study was to determine the efficacy and safety of left atrial appendage (LAA) closure via a percutaneous LAA ligation approach.


BACKGROUND
Embolic stroke is the most devastating consequence of atrial fibrillation. Exclusion of the LAA is believed to decrease the risk of embolic stroke.


METHODS
Eighty-nine patients with atrial fibrillation were enrolled to undergo percutaneous ligation of the LAA with the LARIAT device. The catheter-based LARIAT device consists of a snare with a pre-tied suture that is guided epicardially over the LAA. LAA closure was confirmed with transesophageal echocardiography (TEE) and contrast fluoroscopy immediately, then with TEE at 1 day, 30 days, 90 days, and 1 year post-LAA ligation.


RESULTS
Eighty-five (96%) of 89 patients underwent successful LAA ligation. Eighty-one of 85 patients had complete closure immediately. Three of 85 patients had a ≤ 2-mm residual LAA leak by TEE color Doppler evaluation. One of 85 patients had a ≤ 3-mm jet by TEE. There were no complications due to the device. There were 3 access-related complications (during pericardial access, n = 2; and transseptal catheterization, n = 1). Adverse events included severe pericarditis post-operatively (n = 2), late pericardial effusion (n = 1), unexplained sudden death (n = 2), and late strokes thought to be non-embolic (n = 2). At 1 month (81 of 85) and 3 months (77 of 81) post-ligation, 95% of the patients had complete LAA closure by TEE. Of the patients undergoing 1-year TEE (n = 65), there was 98% complete LAA closure, including the patients with previous leaks.


CONCLUSIONS
LAA closure with the LARIAT device can be performed effectively with acceptably low access complications and periprocedural adverse events in this observational study.
Department of Cardiovascular Surgery and Transplantology, Jagiellonian University, John Paul II Hospital in Krakow, Krakow, Poland.
Krzysztof
K
Bartus
Department of Medicine, University of California San Francisco, San Francisco, California.
Frederick T
FT
Han
Department of Electrocardiology, Jagiellonian University, John Paul II Hospital in Krakow, Krakow, Poland.
Jacek
J
Bednarek
Department of Cardiovascular Surgery and Transplantology, Jagiellonian University, John Paul II Hospital in Krakow, Krakow, Poland.
Jacek
J
Myc
Department of Cardiovascular Surgery and Transplantology, Jagiellonian University, John Paul II Hospital in Krakow, Krakow, Poland.
Boguslaw
B
Kapelak
Department of Cardiovascular Surgery and Transplantology, Jagiellonian University, John Paul II Hospital in Krakow, Krakow, Poland.
Jerzy
J
Sadowski
Department of Electrocardiology, Jagiellonian University, John Paul II Hospital in Krakow, Krakow, Poland.
Jacek
J
Lelakowski
Department of Cardiovascular Surgery and Transplantology, Jagiellonian University, John Paul II Hospital in Krakow, Krakow, Poland.
Stanislaw
S
Bartus
Riverside Methodist Hospital, Columbus, Ohio.
Steven J
SJ
Yakubov
Department of Medicine, University of California San Francisco, San Francisco, California; Cardiovascular Research Institute, University of California San Francisco, San Francisco, California; Institute for Regeneration Medicine, University of California San Francisco, San Francisco, California. Electronic address: lee@medicine.ucsf.edu.
Randall J
RJ
Lee
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D020517:Atrial Appendage / Q000000981:diagnostic imaging / Q000601:surgery*; D001281:Atrial Fibrillation / Q000517:prevention & control*; D021721:Balloon Occlusion; D006348:Cardiac Surgical Procedures / Q000009:adverse effects / Q000295:instrumentation*; D018618:Echocardiography, Doppler, Color; D017548:Echocardiography, Transesophageal; D005260:Female; D005471:Fluoroscopy; D005500:Follow-Up Studies; D006801:Humans; D008026:Ligation / Q000295:instrumentation; D008297:Male; D008875:Middle Aged; D020521:Stroke / Q000517:prevention & control*; D013537:Sutures; D013923:Thromboembolism / Q000517:prevention & control