Early results with the LARIAT device for left atrial appendage exclusion in patients with atrial fibrillation at high risk for stroke and anticoagulation

Abstract

Objectives: To evaluate early outcomes of left atrial appendage (LAA) closure via a percutaneous LAA ligation approach with the SentreHeart LARIAT(™) snare device.

Background: Atrial fibrillation increases the risk of stroke 4-5 fold, which can have devastating outcomes. Exclusion of the LAA is believed to decrease the risk of embolic stroke.

Methods: Twenty-seven patients with atrial fibrillation, a high risk of stroke, and contraindication or intolerance for anticoagulation therapy underwent percutaneous ligation of the LAA with the LARIAT device. Initial LAA closure was confirmed with TEE and contrast fluoroscopy.

Results: The acute procedural success was 92.6%. One patient sustained a perforation of the LAA and was treated conservatively. The patient underwent LAA closure surgically the next day. In one patient the attempt to advance the LARIAT over the LAA was unsuccessful. Patients were followed for a mean of 4 months. Preserved LAA closure was confirmed with a 45 day follow-up TEE in 22 of 25 patients completing the procedure. Peri-operative complications included three cases of pericarditis and one case of a periprocedural CVA due to thrombus formation on the transseptal sheath. During follow-up, there was one stroke thought to be noncardioembolic and one pleural effusion. There were no deaths.

Conclusions: These results show that percutaneous LAA exclusion can be achieved successfully with an acceptable rate of periprocedural and short-term complications. Further studies and longer follow-up are needed to determine whether LAA exclusion lowers the long-term risk of thromboembolic events in patients with AF and contraindications to anticoagulation.

Keywords: cerebrovascular accident; left atrial appendage closure.