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Updated: Jun 7, 2026
Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation
Published on: February 26, 2013
Feasibility of closed-chest ligation of the left atrial appendage in humans
Krzysztof Bartus1, Jacek Bednarek, Jacek Myc
1Department of Cardiovascular Surgery and Transplantology, Jagiellonian University, John Paul II Hospital in Krakow, Poland.
Insights
Surgical suture ligation of the left atrial appendage (LAA) using the LARIAT device is a feasible closed-chest procedure for patients with atrial fibrillation. This catheter-based approach may offer an alternative for those unable to use anticoagulation therapy.
Area of Science:
- Cardiology
- Interventional Cardiology
- Cardiac Surgery
Background:
- Atrial fibrillation (AF) increases embolic event risk, with the left atrial appendage (LAA) a common source of thrombus.
- Left atrial appendage exclusion is a strategy to mitigate AF-related embolic events.
Purpose of the Study:
- To assess the feasibility of closed-chest surgical suture ligation of the LAA in humans using a catheter-based device.
- To evaluate the safety and efficacy of LAA ligation in patients undergoing mitral valve surgery or atrial fibrillation ablation.
Main Methods:
- The LARIAT snare device was used for LAA ligation in 13 patients (2 MVR, 11 AF ablation).
- Procedures involved pericardial access, guide wire placement, and transesophageal echocardiography (TEE) for LAA ostium guidance.
- TEE and contrast fluoroscopy confirmed acute LAA closure post-ligation.
Main Results:
- Successful LAA closure was achieved in 12 of 13 patients (100% in MVR, 91% in AF ablation).
- One AF ablation procedure was terminated due to guidance issues; one patient required thorascopic snare removal due to pectus excavatum.
- No other significant complications were reported.
Conclusions:
- Catheter-based LAA suture ligation is a feasible human procedure.
- This novel approach may benefit AF patients ineligible for anticoagulation.
- Further research is necessary to establish long-term safety and efficacy.
Background:
Atrial fibrillation is associated with an increased risk of embolic events. The left atrial appendage (LAA) is believed to be an incubator for thrombus formation. LAA exclusion has been advocated to potentially reduce embolic events arising from the LAA.
Objective:
The aim of the study was to determine the feasibility of a closed-chest surgical suture ligation of the LAA in man.
Methods:
Thirteen patients undergoing either mitral valve surgery (n = 2) or electrophysiological study and radiofrequency catheter ablation for atrial fibrillation (n = 11) underwent ligation of the LAA with the LARIAT snare device. In patients having an ablation procedure, pericardial access was obtained prior to the patients undergoing radiofrequency catheter ablation. After transseptal catheterization, endocardial and epicaridal magnet-tipped guide wires were positioned under fluoroscopic guidance to stabilize the LAA. Transesophageal echocardiography (TEE) was used as guidance for positioning a marker balloon at the ostium of the LAA. An over-the-wire approach was used to guide the LARIAT snare device over the LAA to allow closure and suture ligation of the LAA. TEE and contrast fluoroscopy were used to confirm acute closure of the LAA.
Results:
Both mitral valve replacement (MVR) patients had complete closure of the LAA determined by visual inspection. Ten of 11 patients having ablation underwent a successful closed-chest LAA ligation procedure with TEE and contrast fluoroscopy verification of closure of the LAA. Only one of 11 procedures was terminated owing to the lack of echocardiography guidance of the snare over the marker balloon. One patient with pectus excavatum did have ligation of his LAA; however, a thorascopic procedure was required to remove the snare from the LAA owing to compression of the LARIAT by the concave sternum. There were no other significant complications.
Conclusions:
Catheter-based surgical suture ligation of the LAA is feasible in humans. This novel catheter approach may be appropriate for patients with atrial fibrillation who are ineligible for anticoagulation therapy. Further investigation is needed to demonstrate the long-term safety and efficacy of LAA closure.
