Abstract 18192: Electrical and Morphologic Characteristics of the Left Atrial Appendage Remnant After an Incomplete Exclusion Using Lariat Device
Background: Left atrial appendage (LAA) is incompletely excluded in some patients after a Lariat ligation. We describe the electrical and mechanical characteristics of these left atrial appendage remnants (LAARs).
Methods: We studied a total of 78 patients with persistent atrial fibrillation who had a Lariat LAA exclusion procedure at the participating institutions followed by atrial fibrillation ablation. Patients underwent a combination LAA ligation and AF ablation. We studied the morphology of the LAA pre and post ligation using CT scans or TEE or LA angiogram. Electrical characteristics of the LAA were assessed during ablation.
Results: Nine patients (mean age of 73 yrs, 70% males) had an incomplete exclusion (12%) with a central leak ranging from 1-5 mm. There was no significant difference in the recurrence rates between the patients who had a leak versus those who did not (3 of 9[33%] vs. 22 of 68 [35%]; p = 1.0). The LAA size reduced by 66% (mean 35±9 cc to 12±8 cc). In patients (n = 5) with a leak between 1 and 3 mm, there was a significant reduction in the size of the LAA beyond the ligation site on the follow-up computed tomography scan, suggestive of possible ischemic remodeling of the LAA despite the small leak at the ligation site. There were 4 pts that had a leak between 3-5 mm and these LAARs were slightly larger than those with smaller leaks. Three out of the 4 had bidirectional conduction when they were taken back for repeat ablation. And could be easily electrically isolated with ablation at the narrow ostium with 2 of these LAARs closing off completely upon repeat imaging. All the patients came off OAC but continued to stay on antiplatelet therapy. There were no strokes or TIAs during follow up at 12 months.
Conclusion: Lariat ligation of the LAA results significant morphological and electrical remodeling resulting volume reduction and electrical inactivity. LAARs are less likely to be electrically inert when the leak is larger suggestive of incomplete ischemic remodeling.
Author Disclosures: D. Lakkireddy: None. R. Afzal: None. D. Atkins: None. M. Turagam: None. M. Earnest: None. R. Lee: None. L. Di Biase: None. A. Natale: None. N. Badhwar: None. A. Rasekh: None. J. Cheng: None.
- © 2016 by American Heart Association, Inc.