Carola Gianni1, Luigi Di Biase2, Chintan Trivedi3, Sanghamitra Mohanty3, Yalçın Gökoğlan3, Mahmut F Güneş3, Rong Bai3, Amin Al-Ahmad3, J David Burkhardt3, Rodney P Horton4, Andrew K Krumerman5, Eugen C Palma5, Miguel Valderrábano6, Douglas Gibson7, Matthew J Price7, Andrea Natale8. 1. Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas; Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy. Electronic address: carola.gianni@unimi.it. 2. Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas; Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York; Department of Biomedical Engineering, University of Texas, Austin, Texas; Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy. 3. Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas. 4. Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas; Department of Biomedical Engineering, University of Texas, Austin, Texas. 5. Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York. 6. Division of Cardiac Electrophysiology, The Methodist Hospital, Houston, Texas. 7. Division of Cardiovascular Diseases, Scripps Clinic, La Jolla, California. 8. Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas; Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York; Department of Biomedical Engineering, University of Texas, Austin, Texas; Division of Cardiovascular Diseases, Scripps Clinic, La Jolla, California; MetroHealth Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio; Division of Cardiology, Stanford University, Stanford, California; Electrophysiology and Arrhythmia Services, California Pacific Medical Center, San Francisco, California; Dell Medical School, University of Texas, Austin, Texas.
Abstract
OBJECTIVES: The aim of this study was to evaluate the incidence and clinical implications of leaks (acute incomplete occlusion, early and late reopenings) following LAA ligation with the LARIAT device. BACKGROUND: Percutaneous LAA ligation with the LARIAT device may represent an alternative for stroke prevention in high-risk patients with atrial fibrillation with contraindications to oral anticoagulation. METHODS: This was a retrospective, multicenter study of 98 consecutive patients undergoing successful LAA ligation with the LARIAT device. Leaks were defined as the presence of flow as evaluated by transesophageal echocardiography (TEE). TEE was performed during the procedure, at 6 and 12 months, and after thromboembolic events. RESULTS: Leaks were detected in 5 (5%), 14 (15%), and 19 (20%) patients at the 3 time points. During follow-up, 5 patients developed neurological events (4 strokes and 1 transient ischemic attack). Two occurred early (1 fatal stroke and 1 stroke with multiple recurrences in the following months), and TEE was not repeated after the events. The remaining 3 occurred late (after 6 months) and were associated with small leaks (<5 mm). In 2 of 3 cases, such a small leak was missed by the standard evaluation on 2-dimensional TEE, being evident only with the aid of 3-dimensional imaging. CONCLUSIONS: Incomplete occlusion of the LAA after LARIAT ligation is relatively common and may be associated with thromboembolic events. Proper long-term surveillance with careful TEE should be considered to detect leaks, which can be managed with either resumption of oral anticoagulation or percutaneous transcatheter closure.
OBJECTIVES: The aim of this study was to evaluate the incidence and clinical implications of leaks (acute incomplete occlusion, early and late reopenings) following LAA ligation with the LARIAT device. BACKGROUND: Percutaneous LAA ligation with the LARIAT device may represent an alternative for stroke prevention in high-risk patients with atrial fibrillation with contraindications to oral anticoagulation. METHODS: This was a retrospective, multicenter study of 98 consecutive patients undergoing successful LAA ligation with the LARIAT device. Leaks were defined as the presence of flow as evaluated by transesophageal echocardiography (TEE). TEE was performed during the procedure, at 6 and 12 months, and after thromboembolic events. RESULTS: Leaks were detected in 5 (5%), 14 (15%), and 19 (20%) patients at the 3 time points. During follow-up, 5 patients developed neurological events (4 strokes and 1 transient ischemic attack). Two occurred early (1 fatal stroke and 1 stroke with multiple recurrences in the following months), and TEE was not repeated after the events. The remaining 3 occurred late (after 6 months) and were associated with small leaks (<5 mm). In 2 of 3 cases, such a small leak was missed by the standard evaluation on 2-dimensional TEE, being evident only with the aid of 3-dimensional imaging. CONCLUSIONS: Incomplete occlusion of the LAA after LARIAT ligation is relatively common and may be associated with thromboembolic events. Proper long-term surveillance with careful TEE should be considered to detect leaks, which can be managed with either resumption of oral anticoagulation or percutaneous transcatheter closure.
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: Ali Hamadanchi; Shun Ijuin; Franz Haertel; Tarek Bekfani; Julian Westphal; Marcus Franz; Sven Moebius-Winkler; P Christian Schulze Journal: J Clin Med Date: 2022-02-18 Impact factor: 4.241