title: Percutaneous catheter-based left atrial appendage ligation and management of periprocedural left atrial appendage perforation with the LARIAT suture delivery system.
abstract: We report an 88-year-old male with coronary artery disease, previously placed left main coronary artery drug-eluting stent, and atrial fibrillation unable to tolerate anticoagulation with warfarin in addition to dual antiplatelet therapy who underwent percutaneous catheter-based ligation of the left atrial appendage. During the procedure, left atrial appendage perforation occurred with resultant pericardial effusion. The novel LARIAT suture delivery system (SentreHEART) allowed immediate and definitive management of this complication and effective ligation of the left atrial appendage. Prospective studies are needed to determine whether this is a safe and effective method for thromboembolism prophylaxis in patients with atrial fibrillation, but its novel design incorporates an immediate resolution to the most-feared complication of catheter-based left atrial appendage manipulation while effectively excluding the left atrial appendage via suture ligation.
authors.affiliation: Swedish Medical Center, Cherry Hill Campus, 500 17th Avenue, Seattle, WA 98122 USA. shettyr23@yahoo.com
authors.forename: Ranjith
authors.initials: R
authors.lastname: Shetty
authors.forename: Joshua P
authors.initials: JP
authors.lastname: Leitner
authors.forename: Ming
authors.initials: M
authors.lastname: Zhang
mesh_terms: D000369:Aged, 80 and over; D000925:Anticoagulants / Q000627:therapeutic use; D020517:Atrial Appendage / Q000293:injuries* / Q000601:surgery*; D006328:Cardiac Catheterization / Q000295:instrumentation / Q000379:methods; D062906:Cardiac Catheters; D006348:Cardiac Surgical Procedures / Q000379:methods; D054855:Drug-Eluting Stents; D006801:Humans; D008026:Ligation; D008297:Male; D062645:Percutaneous Coronary Intervention / Q000295:instrumentation / Q000379:methods*; D013536:Suture Techniques; D013537:Sutures; D013923:Thromboembolism / Q000517:prevention & control; D016896:Treatment Outcome
chemical_list: D000925:Anticoagulants