Percutaneous Left Atrial Appendage Suture Ligation Using the LARIAT Device in Patients With Atrial Fibrillation

Abstract

LAA closure with the LARIAT device can be performed effectively with acceptably low access complications and periprocedural adverse events in this observational study.

2012 HRS/EHRA/ECAS Expert Consensus Statement on Catheter and Surgical Ablation of Atrial Fibrillation: Recommendations for Patient Selection, Procedural Techniques, Patient Management and Follow-up, Definitions, Endpoints, and Research Trial Design

“…1320 The results from the multicenter registry demonstrated a high acute closure rate, but procedural success was limited by bleeding. 1321 More recent results showed that LARIAT device implantation was associated with a lower rate of leaks at 1 year of follow-up and a 1.1% rate of TIA or stroke.…”

EHRA/EAPCI expert consensus statement on catheter-based left atrial appendage occlusion

“…Long-term follow-up revealed severe pericarditis, late stroke, and sudden death in two patients each and late pericardial effusion in one patient. 106 …”

Left Atrial Laceration With Epicardial Ligation Device

“…This type of complication is not reported in previous larger series on percutaneous ligation of the LAA utilizing the same device. [6][7][8] The most common intraoperative complication seen in other series and case reports is right ventricular perforation during epicardial access or perforation of the LAA itself. [6][7][8][9] Three other cases at our institution were performed without complication by the same operators using an identical technique.…”

“…Further studies into the delivery design and technique of percutaneous LAA ligation are warranted, and increased experience with this device has already extended beyond the 137 cases referred to in this report. [6][7][8] …”

“…The cases we will describe represent three of the first six epicardial LAA snare procedures done at our institution; the other 3 cases were completed without incident. In all 6 cases, the preoperative evaluation and LARIAT application technique previously described in the literature was followed, 6) with exceptions noted in each case description. Instructions provided at our institution suggested two separate tightenings of the LARIAT suture separated by a 5-minute window of observation on transesophageal echocardiography (TEE) and angiography.…”