Percutaneous left atrial appendage closure

Jazayeri, Mohammad-Ali; Vuddanda, Venkat; Parikh, Valay; Lakkireddy, Dhanunjaya

doi:10.1097/hco.0000000000000367

Cited by 16 publications

(13 citation statements)

References 41 publications

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“…However, modification of initial technique and use of micropuncture needle and prophylactic colchicine has improved the safety profile of this device dramatically. Considering consistent and broad ranges of benefits shown with this device, it is imperative to consider LARIAT as an acceptable alternative to patients who meet the criteria for LAAC procedure.…”

Section: Discussionmentioning

confidence: 99%

Long‐term clinical outcomes from real‐world experience of left atrial appendage exclusion with LARIAT device

Parikh

Bartuś

Litwinowicz

et al. 2019

Cardiovasc electrophysiol

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Background Left atrial appendage closure (LAAC) with LARIAT has emerged as one of the alternatives to oral anticoagulation (OAC) in patients with nonvalvular atrial fibrillation (AF). Our aim was to study long‐term outcomes in patients undergoing LARIAT procedure. Methods We analyzed patients screened for LARIAT device in four centers between December 2009 and June 2012. Out of these, patients who didn't undergo LAAC with the LARIAT device due to unfavorable LAA morphology and other preprocedural contraindications were included in control group. We analyzed thromboembolism, bleeding events, and mortality between LAA and control group. Results About 153 patients were screened. Out of these, 108 (70.6%) patients underwent LARIAT placement (LAA arm) and 45 (29.4%) excluded patients were included in control arm. There were no differences in CHADS2 and CHA2DS2‐VASc score. Mean HAS‐BLED score was significantly higher in the LARIAT group (3.5 ± 1.06 vs 3.09 ± 1.22, P = .04). Mean follow‐up time (in years) was 6.56 ± 0.84 in LAA and 6.5 ± 1.26 in control arm. During follow‐up period, the LARIAT group was associated with significantly less thromboembolic events (1.9% vs 24%, P < .001), bleeding events (9.2% vs 24.4%, P = .03), and mortality (5.6% vs 20%, P = .01) as compared with the control group. Conclusions Long‐term data from routine clinical practice from our study suggests that LAA exclusion with LARIAT device is an effective treatment in management of nonvalvular AF patients with high risk of stroke, bleeding, and mortality. Further randomized trials, such as aMAZE, will provide more insight in this expanding field.

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Section: Discussionmentioning

confidence: 99%

Long‐term clinical outcomes from real‐world experience of left atrial appendage exclusion with LARIAT device

Parikh

Bartuś

Litwinowicz

et al. 2019

Cardiovasc electrophysiol

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“…Тем не ме-нее авторы отметили наличие потенциально опасных осложнений, связанных с пункцией перикарда, что в последующем может привести к тяжелому экссудативному перикардиту. Такие осложнения зафиксированы в двух исследова-ниях, включавших оценку эффективности и бе-зопасности применения системы у 20 и 27 боль-ных соответственно [8,9]. В каждом исследо-вании сообщалось о 3 пациентах, у которых после проведенных процедур развились тяже-лые перикардиты, требовавшие госпитализа-ции, и в 1 случае появилась необходимость в проведении коронарографии.…”

Section: As a Result Anticoagulation Is Still The Recommended Methodunclassified

Surgical prevention of thromboembolism in atrial fibrillation. The prospect of domestic systems for the left atrial appendage surgical isolation

Bockeria¹,

Биниашвили²,

Mishchenko³

et al. 2017

Ann aritmol

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“…Since these initial studies, the LARIAT has been used in more than 4500 patients in the United States alone [9] , mostly in patients with a contraindication to oral anticoagulation. In the process, multiple additional studies have emerged that report on the safety and efficacy of this procedure.…”

Section: Success and Safety Of Lariat Proceduresmentioning

confidence: 99%

LARIAT Trial Updates

Musat

Mittal

2018

Journal of Atrial Fibrillation

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The thrombus formed within the LAA is responsible for the vast (about 90%) majority of strokes. Anticoagulation, although effective therapy for stroke prevention is not feasible in a significant minority of patients due to various reasons. Two percutaenous LAA exclusion techniques have been developed in an effort to decrease risk for stroke: endocardial closure/plugging of the LAA (Watchman, Amplatzer devices) and epicardial LAA ligation (LARIAT). The aim of this study is to review the trial data to date for the LARIAT device. The LARIAT suture has been used in more than 4500 patients with high success of LAA complete closure (92-100%), mostly in the patients unable to take anticoagulation and in a small minority as antiarrhythmic option. The LARIAT technique has evolved with a change in pericardial access method that resulted in dramatic improvement of safety. LAA closure performance with LARIAT system seems to be similar to Watchman device, with small leaks during follow-up in 6-24% of the cases, which do not to correlate with thrombo-embolic events. LAA has been proven to play an important triggering role in patients with persistent atrial fibrillation. Small studies had shown that LAA ligation with LARIAT could terminate persistent atrial fibrillation and possible improve ablation success. Ongoing aMAZE randomized trial is studying if LAA ligaiton using LARIAT suture leads to improved atrial fibrillation ablation success. Available data suggests that LAA closure using LARIAT epicardial suture is a good alternative for stroke risk reduction in patients who are unable to be on anticoagulation therapy. LARIAT system might improve success of AF ablation for patients with persistent and long persistent AF, pending the results of the ongoing a MAZE trial.

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Percutaneous left atrial appendage closure

Cited by 16 publications

References 41 publications

Long‐term clinical outcomes from real‐world experience of left atrial appendage exclusion with LARIAT device

Long‐term clinical outcomes from real‐world experience of left atrial appendage exclusion with LARIAT device

Surgical prevention of thromboembolism in atrial fibrillation. The prospect of domestic systems for the left atrial appendage surgical isolation

LARIAT Trial Updates

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