title: Short and long-term outcomes of percutaneous left atrial appendage suture ligation: Results from a US multicenter evaluation.
abstract: Published studies of epicardial ligation of left atrial appendage (LAA) have reported discordant results.
  
  
  
  The purpose of this study was to delineate the safety and efficacy of LAA closure with the LARIAT device.
  
  
  
  This is a multicenter registry of 712 consecutive patients undergoing LAA ligation with LARIAT at 18 US hospitals. The primary end point was successful suture deployment, no leak by intraprocedural transesophageal echocardiography (TEE), and no major complication (death, stroke, cardiac perforation, and bleeding requiring transfusion) at discharge. A leak of 2-5 mm on follow-up TEE was the secondary end point.
  
  
  
  LARIAT was successfully deployed in 682 patients (95.5%). A complete closure was achieved in 669 patients (98%), while 13 patients (1.8%) had a trace leak (<2 mm). There was 1 death related to the procedure. Ten patients (1.44%) had cardiac perforation necessitating open heart surgery, while another 14 (2.01%) did not need surgery. The risk of cardiac perforation decreased significantly after the introduction of a micropuncture (MP) needle for pericardial access. Delayed complications (pericarditis requiring >2 weeks of treatment with nonsteroidal anti-inflammatory drugs/colchicine and pericardial and pleural effusion after discharge) occurred in 34 (4.78%) patients, and the risk decreased significantly with the periprocedural use of colchicine. Follow-up TEE (n = 480) showed a leak of 2-5 mm in 6.5% and a thrombus in 2.5%. One patient had a leak of >5 mm.
  
  
  
  LARIAT effectively closes the LAA and has acceptable procedural risks with the evolution of the use of the micropuncture needle for pericardial access and the use of colchicine for mitigating the postinflammatory response associated with LAA ligation and pericardial access.
authors.affiliation: Division of Cardiovascular Diseases, Cardiovascular Research Institute, Kansas City, Kansas. Electronic address: dlakkireddy@kumc.edu.
authors.forename: Dhanunjaya
authors.initials: D
authors.lastname: Lakkireddy
authors.affiliation: Division of Cardiovascular Diseases, Cardiovascular Research Institute, Kansas City, Kansas.
authors.forename: Muhammad R
authors.initials: MR
authors.lastname: Afzal
authors.affiliation: Division of Cardiology, Section of Cardiac Electrophysiology, University of San Francisco and Cardiovascular Research Institute, San Francisco, California.
authors.forename: Randall J
authors.initials: RJ
authors.lastname: Lee
authors.affiliation: Nebraska Heart Institute, Lincoln, Nebraska.
authors.forename: Hosakote
authors.initials: H
authors.lastname: Nagaraj
authors.affiliation: Heart Hospital of Austin, Austin, Texas.
authors.forename: David
authors.initials: D
authors.lastname: Tschopp
authors.affiliation: Heart Rhythm Center, Santa Barbara, California.
authors.forename: Brett
authors.initials: B
authors.lastname: Gidney
authors.affiliation: Vanderbilt University Medical Center, Nashville, Tennessee.
authors.forename: Christopher
authors.initials: C
authors.lastname: Ellis
authors.affiliation: North Shore University Hospital, Manhasset, New York.
authors.forename: Eric
authors.initials: E
authors.lastname: Altman
authors.affiliation: Texas Health Presbyterian Hospital, Dallas, Texas.
authors.forename: Brian
authors.initials: B
authors.lastname: Lee
authors.affiliation: Cedars Sinai, Los Angeles, California.
authors.forename: Saibal
authors.initials: S
authors.lastname: Kar
authors.affiliation: Division of Cardiology, Section of Cardiac Electrophysiology, University of San Francisco and Cardiovascular Research Institute, San Francisco, California.
authors.forename: Nitish
authors.initials: N
authors.lastname: Bhadwar
authors.affiliation: Mercy Hospital, St. Louis, Missouri.
authors.forename: Mauricio
authors.initials: M
authors.lastname: Sanchez
authors.affiliation: Scripps Health, San Diego, California.
authors.forename: Varuna
authors.initials: V
authors.lastname: Gadiyaram
authors.affiliation: Scripps Health, San Diego, California.
authors.forename: Rudolph
authors.initials: R
authors.lastname: Evonich
authors.affiliation: Hall-Garcia Cardiology Associates, Houston, Texas.
authors.forename: Abdi
authors.initials: A
authors.lastname: Rasekh
authors.affiliation: University of Texas, Houston, Texas; Texas Heart Institute, St. Lukes Hospital, Houston, Texas.
authors.forename: Jie
authors.initials: J
authors.lastname: Cheng
authors.affiliation: Medical University of South Carolina, Charleston, South Carolina.
authors.forename: Frank
authors.initials: F
authors.lastname: Cuoco
authors.affiliation: Bryn Mawr Med Associates-Cardiology, Bryn Mawr, Pennsylvania.
authors.forename: Sheetal
authors.initials: S
authors.lastname: Chandhok
authors.affiliation: Division of Cardiovascular Diseases, Cardiovascular Research Institute, Kansas City, Kansas.
authors.forename: Sampath
authors.initials: S
authors.lastname: Gunda
authors.affiliation: Division of Cardiovascular Diseases, Cardiovascular Research Institute, Kansas City, Kansas.
authors.forename: Madhu
authors.initials: M
authors.lastname: Reddy
authors.affiliation: Division of Cardiovascular Diseases, Cardiovascular Research Institute, Kansas City, Kansas.
authors.forename: Donita
authors.initials: D
authors.lastname: Atkins
authors.affiliation: Division of Cardiovascular Diseases, Cardiovascular Research Institute, Kansas City, Kansas.
authors.forename: Sudharani
authors.initials: S
authors.lastname: Bommana
authors.affiliation: Washington University, St. Louis, Missouri.
authors.forename: Phillip
authors.initials: P
authors.lastname: Cuculich
authors.affiliation: Nebraska Heart Institute, Lincoln, Nebraska.
authors.forename: Douglas
authors.initials: D
authors.lastname: Gibson
authors.affiliation: Division of Cardiovascular Diseases, Cardiovascular Research Institute, Kansas City, Kansas.
authors.forename: Jayant
authors.initials: J
authors.lastname: Nath
authors.affiliation: Division of Cardiovascular Diseases, Cardiovascular Research Institute, Kansas City, Kansas.
authors.forename: Ryan
authors.initials: R
authors.lastname: Ferrell
authors.affiliation: Division of Cardiovascular Diseases, Cardiovascular Research Institute, Kansas City, Kansas.
authors.forename: Earnest
authors.initials: E
authors.lastname: Matthew
authors.affiliation: Loyola University Medical Center, Maywood, Illinois.
authors.forename: David
authors.initials: D
authors.lastname: Wilber
mesh_terms: D000368:Aged; D020517:Atrial Appendage / Q000601:surgery*; D001281:Atrial Fibrillation / Q000401:mortality / Q000601:surgery*; D013504:Cardiovascular Surgical Procedures / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods; D005260:Female; D006335:Heart Injuries / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control; D006801:Humans; D007431:Intraoperative Complications / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control; D008026:Ligation / Q000009:adverse effects / Q000379:methods; D000069451:Long Term Adverse Effects / Q000453:epidemiology*; D008297:Male; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care; D010493:Pericarditis / Q000453:epidemiology / Q000209:etiology; D011183:Postoperative Complications / Q000453:epidemiology*; D011677:Punctures / Q000295:instrumentation / Q000379:methods; D012042:Registries / Q000706:statistics & numerical data; D014481:United States / Q000453:epidemiology
keywords: Atrial fibrillation; LARIAT; Left atrial appendage; Stroke