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Updated: Feb 16, 2026
The WATCHMAN Left Atrial Appendage Closure Device for Atrial Fibrillation
Published on: February 28, 2012
Leaks after left atrial appendage ligation with Lariat device: Incidence, pathophysiology, clinical implications and
Bharath Yarlagadda1, Valay Parikh1, Tawseef Dar1
1Division of Cardiovascular Diseases, Cardiovascular Research Institute, University of Kansas Hospital & Medical Center, Kansas City, KS.
Insights
The Lariat procedure for left atrial appendage (LAA) closure can result in leaks, potentially impacting stroke prevention. This review examines LAA leak incidence, causes, and closure methods, including a case study.
Area of Science:
- Cardiology
- Interventional Cardiology
- Medical Devices
Background:
- Catheter-based left atrial appendage (LAA) closure offers an alternative to oral anticoagulation for stroke prevention.
- The Lariat procedure uses a percutaneous epicardial approach for LAA ligation, aiming to prevent thrombus formation.
Purpose of the Study:
- To review the incidence, pathophysiology, clinical implications, and closure techniques for leaks occurring after the Lariat procedure.
- To present a case study of a Lariat leak successfully closed with an Amplatzer septal occluder.
Main Methods:
- Literature review focusing on Lariat procedure-related LAA leaks.
- Case report detailing the management of a post-Lariat LAA leak.
Main Results:
- Lariat ligation, while effective, can be associated with leaks in a subset of patients.
- Leak incidence and timing (immediate or follow-up) are variable, with ongoing debate regarding their electrical and mechanical consequences.
- The presented case demonstrates successful closure of a Lariat leak using an Amplatzer septal occluder.
Conclusions:
- Leaks after Lariat procedures require careful consideration due to potential clinical implications.
- Further research is needed to fully understand the long-term effects of LAA leaks and optimize closure strategies.
- Percutaneous closure devices may offer an effective solution for managing Lariat-associated LAA leaks.
Abstract:
Catheter based left atrial appendage (LAA) closure techniques are emerging as a promising alternative for stroke prevention in patients who cannot tolerate oral anticoagulation. Lariat procedure involves percutaneous catheter based epicardial ligation of the LAA with a suture via an endo-epicardial hybrid approach. It offers the advantage of not leaving behind a focus for thrombus formation or embolization. Similar to surgical ligation of the left atrial appendage, Lariat ligation is limited by leaks in a small percentage of patients. The incidence of leaks is variable and can be seen in the immediate post procedure period or during follow up. The electrical and mechanical implications of leaks are still under debate. In this review, we discuss the incidence, pathophysiology, clinical implications and methods of closure of leaks after Lariat. In the end, we present a case of a Lariat leak closed with an Amplatzer septal occluder.
