Atrial fibrillation (AF) increases by fivefold a patient's risk for thromboembolic
stroke. The main source of emboli in AF is the left atrial appendage (LAA). Therefore,
LAA closure could reduce the risk for thromboembolic events in AF. The investigators
report the first United States experience with a novel percutaneous LAA closure device,
the Lariat snare device, and its outcomes in 21 patients with AF, CHADS2 scores ≥2, and contraindications to anticoagulation. The LAA was closed with a snare
containing suture from within the pericardial space. The intraoperative success of
the procedure was confirmed by left atrial angiography and transesophageal echocardiographic
color Doppler flow. The effectiveness of the procedure was evaluated by follow-up
transesophageal echocardiography. The incidence of periprocedural and short-term complications
was assessed by reviewing medical records. Twenty patients (100%) had successful LAA
exclusion that was preserved at 96 ± 77 days. No patient had a stroke during an average
of 352 ± 143 days of follow-up. One patient had right ventricular perforation and
tamponade that required surgical exploration and repair. Two patients required prolonged
hospitalization: 1 because of pericardial effusion that required repeat pericardiocentesis
and 1 because of noncardiac co-morbidities. Three patients developed pericarditis
<1 month after the procedure, of whom 1 had associated pericardial effusion that required
drainage. In conclusion, percutaneous LAA exclusion can be achieved successfully and
with an acceptable incidence of periprocedural and short-term complications. Further
studies are needed to determine whether LAA exclusion lowers the long-term risk for
thromboembolic events in patients with AF and contraindications to anticoagulation.
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Article Info
Publication History
Published online: January 11, 2013
Accepted:
November 29,
2012
Received in revised form:
November 29,
2012
Received:
July 27,
2012
Footnotes
See page 873 for disclosure information.
Identification
Copyright
© 2013 Published by Elsevier Inc.
