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

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*

*Corresponding author for this work
8 Citations (Scopus)

Abstract

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.

Original languageEnglish
JournalClinical Research in Cardiology
Volume107
Issue number12
Pages (from-to)1139-1147
Number of pages9
ISSN1861-0684
DOIs
Publication statusPublished - 01.12.2018

Research Areas and Centers

  • Centers: Cardiological Center Luebeck (UHZL)

DFG Research Classification Scheme

  • 205-12 Cardiology, Angiology

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