title: Initial experience with post Lariat left atrial appendage leak closure with Amplatzer septal occluder device and repeat Lariat application.
abstract: BACKGROUND
  Left atrial appendage (LAA) ligation with the Lariat device is a therapeutic option to prevent thromboembolic stoke in patients with nonvalvular atrial fibrillation (AF) at high risk for systemic thromboembolization and bleeding related to use of anticoagulation. In rare cases, this procedure could leave the LAA incompletely ligated with continued risk of stroke.
  
  
  OBJECTIVE
  The purpose of this study was to investigate the incidence and characteristics of LAA leak following ligation using the Lariat device and the feasibility of leak closure with the Amplatzer septal occluder device or a repeat Lariat application.
  
  
  METHODS
  Seventy-one consecutive patients who underwent LAA ligation by the Lariat device were followed-up with transesophageal echocardiography to evaluate for the presence of appendage leaks, characterization of the leaks, and the presence of any thrombus. Patients with LAA leaks underwent definite closure of the leak.
  
  
  RESULTS
  Six patients had LAA leaks with a mean leak size of 4.3 ± 0.6 mm. All leaks were concentric in nature. None of the patients had LAA thrombus. Leaks in 5 of these patients were successfully closed using an Amplatzer septal occluder device (St. Jude Medical); the leak in the sixth patient was closed using a repeat Lariat procedure.
  
  
  CONCLUSIONS
  LAA leaks from incomplete ligation of the LAA following the Lariat procedure are not uncommon and could be successfully closed with an Amplatzer septal occluder device or a repeat Lariat procedure.
authors.affiliation: Section of Electrophysiology, Bloch Heart Rhythm Center, University of Kansas Hospital, Mid America Cardiology, Kansas City, Kansas.
authors.forename: Anand M
authors.initials: AM
authors.lastname: Pillai
authors.affiliation: Section of Electrophysiology, Bloch Heart Rhythm Center, University of Kansas Hospital, Mid America Cardiology, Kansas City, Kansas.
authors.forename: Arun
authors.initials: A
authors.lastname: Kanmanthareddy
authors.affiliation: Section of Electrophysiology, Bloch Heart Rhythm Center, University of Kansas Hospital, Mid America Cardiology, Kansas City, Kansas.
authors.forename: Matthew
authors.initials: M
authors.lastname: Earnest
authors.affiliation: Section of Electrophysiology, Bloch Heart Rhythm Center, University of Kansas Hospital, Mid America Cardiology, Kansas City, Kansas.
authors.forename: Madhu
authors.initials: M
authors.lastname: Reddy
authors.affiliation: Section of Electrophysiology, Bloch Heart Rhythm Center, University of Kansas Hospital, Mid America Cardiology, Kansas City, Kansas.
authors.forename: Ryan
authors.initials: R
authors.lastname: Ferrell
authors.affiliation: Section of Electrophysiology, Bloch Heart Rhythm Center, University of Kansas Hospital, Mid America Cardiology, Kansas City, Kansas.
authors.forename: Jayanth
authors.initials: J
authors.lastname: Nath
authors.affiliation: Section of Electrophysiology, Bloch Heart Rhythm Center, University of Kansas Hospital, Mid America Cardiology, Kansas City, Kansas.
authors.forename: Jayasree
authors.initials: J
authors.lastname: Pillarisetti
authors.affiliation: Section of Electrophysiology, Bloch Heart Rhythm Center, University of Kansas Hospital, Mid America Cardiology, Kansas City, Kansas.
authors.forename: Ajay
authors.initials: A
authors.lastname: Vallakati
authors.affiliation: Section of Electrophysiology, Bloch Heart Rhythm Center, University of Kansas Hospital, Mid America Cardiology, Kansas City, Kansas. Electronic address: dlakkireddy@kumc.edu.
authors.forename: Dhanunjaya
authors.initials: D
authors.lastname: Lakkireddy
mesh_terms: D000368:Aged; D020517:Atrial Appendage / Q000000981:diagnostic imaging / Q000601:surgery*; D001281:Atrial Fibrillation / Q000000981:diagnostic imaging / Q000601:surgery*; D017548:Echocardiography, Transesophageal; D005260:Female; D006801:Humans; D015994:Incidence; D008026:Ligation; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology*; D012086:Reoperation; D055989:Septal Occluder Device; D020521:Stroke / Q000517:prevention & control; D013536:Suture Techniques / Q000295:instrumentation*; D016896:Treatment Outcome
keywords: Amplatzer septal occluder; Atrial fibrillation; Lariat procedure; Left atrial appendage; Thromboembolic stroke