Ligation of LAA via epicardial access safe, effective in achieving LAA exclusion

SAN FRANCISCO — Percutaneous left atrial appendage closure device is safe and effective with epicardial approach, researchers reported at the Heart Rhythm Society Annual Scientific Sessions.

Researchers enrolled 750 consecutive patients undergoing left atrial appendage (LAA) ligation with the Lariat device (SentreHeart) at 18 U.S. hospitals in this retrospective study. The primary endpoint was successful suture deployment with no leaks and no major complications at discharge. Secondary endpoints included a leak of 2 mm to 5 mm on a follow-up transesophageal echocardiography.

According to results, successful deployment of the Lariat device was achieved in 705 (96%) patients. Of these, 692 patients had complete closure. Trace leaks were found in 13 patients (1.8%), but there were no significant leaks greater than 2 mm. Patients with leaks were treated with 2 weeks of nonsteroidal anti-inflammatory drugs or colchicine, and pericardial and pleural effusion after discharge. Periprocedural colchicine reduced the accumulation of delayed complications (8.4% vs. 1.58%; P < .0001). On follow-up transesophageal echocardiography, 6.5% of 480 patients had a leak of 2 mm to 5 mm and 2.5% had thrombus.

“[The Lariat] fulfills an unmet need in patients with contraindication to anticoagulation,” M. Rizwan Afzal, MD, a cardiac fellow at the University of Kansas Medical Center, said during a presentation. “The use of [micropuncture] needle for epicardial access and peri-procedural colchicine improves safety of the procedure.” – by Tracey Romero

Reference:

Afzal M, et al. Oral Abstract Sessions. Presented at: Heart Rhythm Society Annual Scientific Sessions; May 4-7, 2016; San Francisco.

Disclosure: Afzal reports no relevant financial disclosures.