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Updated: May 17, 2026
Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation
Published on: February 26, 2013
Percutaneous catheter-based left atrial appendage ligation and management of periprocedural left atrial appendage
Ranjith Shetty1, Joshua P Leitner, Ming Zhang
1Swedish Medical Center, Cherry Hill Campus, 500 17th Avenue, Seattle, WA 98122 USA. shettyr23@yahoo.com
Insights
This study highlights a new method for left atrial appendage closure in patients with atrial fibrillation who cannot tolerate blood thinners. The LARIAT system successfully managed a complication during the procedure, offering a potential new treatment option.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
Background:
- Atrial fibrillation (AF) patients often require anticoagulation for thromboembolism prophylaxis.
- Dual antiplatelet therapy (DAPT) combined with warfarin is challenging for some AF patients.
- Left atrial appendage (LAA) ligation is an alternative to anticoagulation for stroke prevention.
Observation:
- A patient with coronary artery disease and AF, intolerant to warfarin and DAPT, underwent percutaneous LAA ligation.
- Left atrial appendage perforation and pericardial effusion occurred during the procedure.
- The LARIAT suture delivery system was used for immediate management of the complication.
Findings:
- The LARIAT system effectively managed the iatrogenic perforation and pericardial effusion.
- Successful and definitive ligation of the left atrial appendage was achieved.
- The device demonstrated immediate resolution of a feared procedural complication.
Implications:
- The LARIAT system offers a potential solution for managing complications during LAA ligation.
- This technology may provide an alternative for thromboembolism prophylaxis in high-risk AF patients.
- Further prospective studies are necessary to validate the safety and efficacy of this LAA closure technique.
Abstract:
We report an 88-year-old male with coronary artery disease, previously placed left main coronary artery drug-eluting stent, and atrial fibrillation unable to tolerate anticoagulation with warfarin in addition to dual antiplatelet therapy who underwent percutaneous catheter-based ligation of the left atrial appendage. During the procedure, left atrial appendage perforation occurred with resultant pericardial effusion. The novel LARIAT suture delivery system (SentreHEART) allowed immediate and definitive management of this complication and effective ligation of the left atrial appendage. Prospective studies are needed to determine whether this is a safe and effective method for thromboembolism prophylaxis in patients with atrial fibrillation, but its novel design incorporates an immediate resolution to the most-feared complication of catheter-based left atrial appendage manipulation while effectively excluding the left atrial appendage via suture ligation.
