Marc A Miller1, Sandeep R Gangireddy1, Shephal K Doshi2, Arash Aryana3, Jacob S Koruth1, Susie Sennhauser1, Andre d'Avila1, Srinivas R Dukkipati1, Petr Neuzil4, Vivek Y Reddy5. 1. Helmsley Electrophysiology Center, Mount Sinai School of Medicine, New York, New York. 2. Pacific Heart Institute, Santa Monica, California. 3. Regional Cardiology Associates, Mercy Heart and Vascular Institute, Sacramento, California. 4. Cardiology Department, Homolka Hospital, Prague, Czech Republic. 5. Helmsley Electrophysiology Center, Mount Sinai School of Medicine, New York, New York. Electronic address: vivek.reddy@mountsinai.org.
Abstract
BACKGROUND: Pericardial suture ligation of the left atrial appendage (LAA) may be an alternative to endoluminal devices for stroke prevention in patients with atrial fibrillation, but multicenter safety and efficacy data in high-risk patients with contraindications to oral anticoagulation are lacking. OBJECTIVE: The purpose of this study was to report the outcomes of consecutive cases of pericardial suture ligation of the LAA in high-risk patients performed at 4 centers. METHODS: The cohort included 41 consecutive patients who underwent LAA closure with the LARIAT system. Epicardial and transeptal access was obtained, and the epicardial snare was advanced over an endo-epicardial magnetic-tipped guidewire to close the LAA. Transesophageal echocardiography was used to confirm LAA exclusion. RESULTS: Mean age was 75 ± 10 years, mean CHADS2 score was 3.0 ± 1.3, and mean HAS-BLED score was 4.4 ± 1.4. These patients accumulated 24.6 person-years of follow-up. Acute LAA closure was achieved in 38 patients (93%). Transesophageal echocardiography or computerized tomographic angiography performed up to 3.3 ± 0.8 months after the procedure demonstrated LAA leakage in 24% of patients. One patient (2%) had a transient ischemic attack, and 8 (20%) developed pericardial effusions requiring pericardiocentesis. Four cases (9%) were complicated by perforation of the LAA, with 2 of these patients requiring open surgical correction. CONCLUSION: This multicenter experience revealed that pericardial suture ligation with the LARIAT system is technically feasible and acutely efficacious. However, additional improvements are required to minimize the rate of pericardial complications. A randomized study is warranted to accurately define the long-term efficacy and safety profile of percutaneous epicardial suture ligation.
BACKGROUND: Pericardial suture ligation of the left atrial appendage (LAA) may be an alternative to endoluminal devices for stroke prevention in patients with atrial fibrillation, but multicenter safety and efficacy data in high-risk patients with contraindications to oral anticoagulation are lacking. OBJECTIVE: The purpose of this study was to report the outcomes of consecutive cases of pericardial suture ligation of the LAA in high-risk patients performed at 4 centers. METHODS: The cohort included 41 consecutive patients who underwent LAA closure with the LARIAT system. Epicardial and transeptal access was obtained, and the epicardial snare was advanced over an endo-epicardial magnetic-tipped guidewire to close the LAA. Transesophageal echocardiography was used to confirm LAA exclusion. RESULTS: Mean age was 75 ± 10 years, mean CHADS2 score was 3.0 ± 1.3, and mean HAS-BLED score was 4.4 ± 1.4. These patients accumulated 24.6 person-years of follow-up. Acute LAA closure was achieved in 38 patients (93%). Transesophageal echocardiography or computerized tomographic angiography performed up to 3.3 ± 0.8 months after the procedure demonstrated LAA leakage in 24% of patients. One patient (2%) had a transient ischemic attack, and 8 (20%) developed pericardial effusions requiring pericardiocentesis. Four cases (9%) were complicated by perforation of the LAA, with 2 of these patients requiring open surgical correction. CONCLUSION: This multicenter experience revealed that pericardial suture ligation with the LARIAT system is technically feasible and acutely efficacious. However, additional improvements are required to minimize the rate of pericardial complications. A randomized study is warranted to accurately define the long-term efficacy and safety profile of percutaneous epicardial suture ligation.
Authors: Thomas Fink; Michael Schlüter; Roland Richard Tilz; Christian-Hendrik Heeger; Christine Lemes; Tilmann Maurer; Bruno Reissmann; Laura Rottner; Francesco Santoro; Shibu Mathew; Andreas Rillig; Feifan Ouyang; Karl-Heinz Kuck; Andreas Metzner Journal: Clin Res Cardiol Date: 2018-06-07 Impact factor: 5.460
Authors: Toby Rogers; Kanishka Ratnayaka; William H Schenke; Anthony Z Faranesh; Jonathan R Mazal; William W O'Neill; Adam B Greenbaum; Robert J Lederman Journal: Catheter Cardiovasc Interv Date: 2014-10-28 Impact factor: 2.692