Abstract 16064: Percutaneous Left Atrial Appendage Exclusion with Lariat is Safe and Effective in Patients with Atrial Fibrillation, Increased Stroke Risk, and Contraindications for Anticoagulation
Introduction:Atrial fibrillation (AF) is associated with a 5-fold increase in the risk of thromboembolic stroke. The main source of emboli in AF is the left atrial appendage (LAA). Therefore, LAA closure may be a valid strategy for reducing the risk of thromboembolic events in AF. Objective:We evaluated the safety and effectiveness of a novel percutaneous LAA closure device and its short-term outcomes in patients with contraindications to anticoagulation therapy.
Methods:Twenty-one patients with AF, a CHADS2 score of 2 or more, and contraindications to anticoagulation underwent percutaneous exclusion of the LAA with the Lariat snare device. A magnet-tipped wire was advanced into the LAA through an atrial transseptal sheath, and another such wire was advanced from within the pericardial space. These wires were then adjoined by virtue of their magnetic attraction. A snare containing suture was advanced within the pericardial space over the magnet-tipped wire and deployed proximal to a balloon placed in the LAA body. The short-term success of the procedure was confirmed by left atrial (LA) angiography and TEE color Doppler flow. The effectiveness of the procedure was evaluated by follow-up TEE. The incidence of periprocedural and short-term complications was assessed by a review of medical records.
Results:Twenty patients had successful LAA exclusion that was preserved at 80±48 days. The procedure was aborted in 1 patient because of thrombus visualized in the LAA during intraoperative TEE. One patient had RV perforation and tamponade requiring surgical exploration and repair. Two patients required prolonged hospitalization: 1 because of pericardial effusion requiring repeat pericardiocentesis and 1 because of noncardiac comorbidities. Two patients developed pericarditis within 1 month of the procedure, of whom 1 had associated pericardial effusion requiring drainage. No patient had a stroke during short-term follow-up.
Conclusions:PercutaneousLAA exclusion can be achieved successfully and with a low incidence of acute and short-term complications. Further studies are needed to determine whether LAA exclusion lowers the long-term risk of thromboembolic events in patients with AF and contraindications for anticoagulation.
- © 2012 by American Heart Association, Inc.