Acute and long-term outcomes of epicardial left atrial appendage ligation with the second-generation LARIAT device: a high-volume electrophysiology center experience

Background: Epicardial left atrial appendage (LAA) ligation may be an alternative to oral anticoagulation management and to endocardial LAA closure devices. We report long-term results after LAA ligation with the second-generation LARIAT device. Methods: Retrospective study was performed on patients who underwent LAA ligation at our center. Follow-up included patient visits and transesophageal echocardiography (TEE) to assess LAA-to-LA leakages. Results: 76 patients with an indication for LAA closure underwent cardiac CT-based screening with 16 patients (21%) excluded from LAA ligation due to anatomical reasons. Finally, 48 patients (70 ± 9 years, 23 women) underwent LAA ligation with successful LAA closure in 44 patients (92%). Major periprocedural complications occurred in three patients (6%; one major femoral bleeding, one pneumothorax with surgical drainage, one right ventricular perforation with concomitant stroke). Additionally, minor complications occurred in 27% of the patients with mild pericarditis in eight of these patients being the most common adverse event. Clinical follow-up (median of 443 days, interquartile range 158; 773) was obtained from 38 patients. One thromboembolic event (transient ischemic attack) occurred. Complete LAA closure was demonstrated in 23/35 patients (66%) with TEE follow-up. Major leakages > 5 mm without documentation of intracardiac thrombi were documented in four patients (11%). Conclusions: Epicardial LAA ligation with the second-generation LARIAT device was associated with a high acute success rate comparable to endocardial LAA closure devices. LAA ligation was accompanied by a relevant incidence of periprocedural complications with mild pericarditis being the most common adverse event. Follow-up demonstrated a moderate incidence of leakages after LAA exclusion, no intracardiac thrombus formation and only a single thromboembolic event. The effectiveness in preventing thromboembolic events needs further investigation in larger patient cohorts.