Left atrial laceration with epicardial ligation device

Area of Science:

• Cardiovascular Surgery
• Interventional Cardiology
• Medical Device Technology

Background:

• Atrial fibrillation patients unable to use anticoagulation are at high risk for embolic stroke.
• Percutaneous left atrial appendage ligation is an emerging alternative to anticoagulation.
• The LARIAT device uses epicardial suture ligation for left atrial appendage closure.

Observation:

• This case series details three patients experiencing left atrial laceration and cardiac tamponade after LARIAT device placement.
• Complications occurred shortly after device delivery, not related to access procedures.
• Patients developed tamponade rapidly, requiring intervention despite drainage attempts.

Findings:

• Left atrial laceration and subsequent cardiac tamponade are significant complications of epicardial suture ligation.
• Device delivery, not access, was implicated as the cause of injury.
• Prompt recognition and surgical backup are crucial for managing these adverse events.

Implications:

• Novel percutaneous left atrial appendage ligation devices carry risks of serious cardiac injury.
• Cardiovascular surgery backup, including cardiopulmonary bypass, is essential during these procedures.
• Further research and device refinement are needed to improve safety and efficacy.