Background: The left atrial appendage (LAA) is the source of considerable
thromboemboli responsible for embolic strokes in patients with atrial
fibrillation (AF). The LARIAT™ suturing device has been used to ligate the LAA
and negate the use of systemic anticoagulation. However, its efficacy and
stroke outcome is still unknown.
Methods: We retrospectively
evaluated the clinical status and risk of occurrence of systemic emobolic
events, strokes, transient ischemic attacks, and procedure related
complications in patients after LAA ligation using the LARIAT™ device.
suture was successfully delivered in 21 patients. Mean follow up time was
17.2+-3.3 months. The average HAS-BLED score was 3.3+/-1.1. Only 1 patient
developed clinical symptoms of stroke 7 days post procedure. One patient had
uncomplicated perioperative bleeding not requiring blood transfusion. One patient developed transient ECG changes of
ischemia during mapping for ablation following the LAA ligation and
subsequently, underwent bypass surgery. Three patient developed post-procedural
pericarditis and were medically managed. Three patients died from non-LAA
ligation related conditions including congestive heart failure, lung
cancer, and severe coronary disease. We observed a 32% and 30% reduction in the
annual risk of stroke when compared to the expected risk of stroke based on the
CHADS2 and CHA2DS2-VASc score respectively.
Conclusion: LAA ligation using the LARIAT™ suturing
device is clinically feasible in carefully selected patients. This study has the longest follow up period
to date, however further studies are required to determine the efficacy of
stroke reduction and long-term clinical outcomes.
Credits: Soidjon Khodjaev; Duong Le; Wei Rao; Remo Morelli