A collective European experience with left atrial appendage suture ligation using the LARIAT+ device

Abstract

Aims We report the collective European experience of percutaneous left atrial appendage (LAA) suture ligation using the recent generation LARIAT+ suture delivery device. Methods and results A total of 141 patients with non-valvular atrial fibrillation and contraindication to oral anticoagulation (OAC), thrombo-embolic events despite OAC or electrical LAA isolation were enrolled at seven European hospitals to undergo LAA ligation. Patients were followed up by clinical visits and transoesophageal echocardiography (TOE) following LAA closure. Left atrial appendage ligation was completed in 138/141 patients (97.8%). Three patients did not undergo attempted deployment of the LARIAT device due to pericardial adhesion after previous epicardial ventricular tachycardia ablation (n = 1), a pericardial access-related complication (n = 1), and multiple posterior LAA lobes (n = 1). Serious 30-day procedural adverse events occurred in 4/141 patients (2.8%). There were two device-related LAA perforations (1.4%) not resulting in any corrective intervention as the LAA was completely sealed with the LARIAT. Minor adverse events occurred in 19 patients (13.5%), including two pericardial effusions due to procedure-related pericarditis requiring pericardiocentesis. Transoesophageal echocardiography was performed after LAA ligation in 103/138 patients (74.6%) after a mean of 181 ± 72 days. Complete LAA closure was documented in 100 patients (97.1%). Two patients (1.8% of patients with follow-up) experienced a transient ischaemic attack at 4 and 7 months follow-up, although there was no leak observed with TOE. There were two deaths during long-term follow-up which were both not device related. Conclusion Initial experience with the LARIAT+ device demonstrates feasibility of LAA exclusion. Further larger prospective studies with longer follow-up are warranted.

Safety and efficacy of left atrial appendage closure using an epicardial suture snaring device: Systematic review and current status

“…Improved features compared to the first generation of the device include snare expansion from 40 to 45 mm, improved catheter torque‐ability, and orientation under fluoroscopy. Initial European experience with the device by Tilz et al demonstrated a 97.1% success in LAA closure (<5 mm residual leak) after a mean follow up of 6 months, with acceptably low (2.8%) access complications and peri‐procedural serious adverse events 33 . Larger prospective studies with longer follow up periods are warranted.…”

“…32 Improved features compared to the first generation of the device include and peri-procedural serious adverse events. 33 Larger prospective studies with longer follow up periods are warranted. Insights from the LAFIT-LARIAT registry show that LAA exclusion improves mechanical function of the left atrium resulting in reverse left atrial remodeling.…”

Percutaneous Treatment Approaches in Atrial Fibrillation: Current Landscape and Future Perspectives

“…The second-generation LARIAT + has improved features, such as snare expansion from 40 mm to 45 mm, the addition of a platinum–iridium ‘L’ Marker that allows identification of the device orientation under fluoroscopy, and a stainless steel wire braid on catheter shaft that provides improved ‘torque-ability’ of the catheter. Initial reports from registries highlight the high rates of acute and short-term LAAC, paired with low periprocedural complications and few thromboembolic events at longer term follow-up [ 205 , 206 ].…”

Electrical Isolation of the Left Atrial Appendage - A New Frontier in the Treatment for Atrial Fibrillation

“…The benefit of using colchicine has also been demonstrated by Gunda et al [30]. Additional data on complication rates have been reported by other groups [31][32][33]. As part of a systematic review by Chaterjee et al published in 2015, the authors included a specific analysis of adverse events from real-world practice using the FDA MAUDE database [31].…”

“…As part of a systematic review by Chaterjee et al published in 2015, the authors included a specific analysis of adverse events from real-world practice using the FDA MAUDE database [31]. Very recently, Tilz et al reported on the collective European experience [32]. In their series of 141 patients, successful deployment of the Lariat device was achieved in 97.8%.…”