Retrospective Evaluation Of Novel Percutaneous Left Atrial Appendage Ligation Using The Lariat Suturing Device: Single Center Initial Experience

Citation: Soidjon Khodjaev MD, Duong Le, MD, MSc, Wei Rao MD, Remo Morelli MD, FACC

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.

Results: Permanent 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.