Related Experiment Video
Updated: Apr 26, 2026
Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation
Published on: February 26, 2013
Multicenter study on acute and long-term safety and efficacy of percutaneous left atrial appendage closure using an
Marc A Miller1, Sandeep R Gangireddy1, Shephal K Doshi2
1Helmsley Electrophysiology Center, Mount Sinai School of Medicine, New York, New York.
Insights
Pericardial suture ligation of the left atrial appendage (LAA) using the LARIAT system is feasible for stroke prevention in high-risk atrial fibrillation patients. Further improvements are needed to reduce complications, warranting further study.
Area of Science:
- Cardiology
- Medical Devices
- Interventional Procedures
Background:
- Pericardial suture ligation of the left atrial appendage (LAA) offers an alternative to endoluminal devices for stroke prevention in atrial fibrillation.
- Limited multicenter safety and efficacy data exist for high-risk patients contraindicated for oral anticoagulation.
Purpose of the Study:
- To report outcomes of consecutive pericardial suture ligation of the LAA in high-risk patients across four centers.
- To evaluate the safety and acute efficacy of the LARIAT system for LAA closure.
Main Methods:
- 41 high-risk patients underwent LAA closure using the LARIAT system via epicardial and transeptal access.
- An epicardial snare was advanced over a magnetic-tipped guidewire for LAA closure.
- Transesophageal echocardiography confirmed LAA exclusion.
Main Results:
- Acute LAA closure was achieved in 93% of patients (38/41).
- LAA leakage occurred in 24% of patients by 3.3 months post-procedure.
- Complications included transient ischemic attack (2%), pericardial effusions (20%), and LAA perforation (9%).
Conclusions:
- Pericardial suture ligation with the LARIAT system is technically feasible and acutely effective for LAA closure.
- Improvements are needed to minimize pericardial complications.
- A randomized study is essential to define the long-term efficacy and safety of this percutaneous epicardial suture ligation technique.
Background:
Pericardial suture ligation of the left atrial appendage (LAA) may be an alternative to endoluminal devices for stroke prevention in patients with atrial fibrillation, but multicenter safety and efficacy data in high-risk patients with contraindications to oral anticoagulation are lacking.
Objective:
The purpose of this study was to report the outcomes of consecutive cases of pericardial suture ligation of the LAA in high-risk patients performed at 4 centers.
Methods:
The cohort included 41 consecutive patients who underwent LAA closure with the LARIAT system. Epicardial and transeptal access was obtained, and the epicardial snare was advanced over an endo-epicardial magnetic-tipped guidewire to close the LAA. Transesophageal echocardiography was used to confirm LAA exclusion.
Results:
Mean age was 75 ± 10 years, mean CHADS2 score was 3.0 ± 1.3, and mean HAS-BLED score was 4.4 ± 1.4. These patients accumulated 24.6 person-years of follow-up. Acute LAA closure was achieved in 38 patients (93%). Transesophageal echocardiography or computerized tomographic angiography performed up to 3.3 ± 0.8 months after the procedure demonstrated LAA leakage in 24% of patients. One patient (2%) had a transient ischemic attack, and 8 (20%) developed pericardial effusions requiring pericardiocentesis. Four cases (9%) were complicated by perforation of the LAA, with 2 of these patients requiring open surgical correction.
Conclusion:
This multicenter experience revealed that pericardial suture ligation with the LARIAT system is technically feasible and acutely efficacious. However, additional improvements are required to minimize the rate of pericardial complications. A randomized study is warranted to accurately define the long-term efficacy and safety profile of percutaneous epicardial suture ligation.
