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Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation
Published on: February 26, 2013
The Strengths and Weaknesses of Left Atrial Appendage Ligation or Exclusion (LARIAT, AtriaClip, Surgical Suture)
Randall J Lee1, Thorsten Hanke2
1Cardiac Electrophysiology, University of California, San Francisco, 500 Parnassus Avenue, Box 1354, San Francisco, CA 94143, USA.
Insights
Left atrial appendage (LAA) exclusion, a procedure with over 60 years of history, effectively prevents thrombus formation and reduces arrhythmia triggers. Various surgical and percutaneous methods are discussed for LAA management.
Area of Science:
- Cardiology
- Cardiac Surgery
- Electrophysiology
Background:
- The left atrial appendage (LAA) is linked to thrombus formation and atrial fibrillation.
- Established surgical methods for LAA exclusion exist.
- Newer percutaneous epicardial approaches are emerging.
Purpose of the Study:
- To review epicardial LAA exclusion techniques.
- To discuss the efficacy of different LAA exclusion methods.
- To explore the impact of LAA exclusion on thrombus, arrhythmia, and neuroendocrine function.
Main Methods:
- Review of surgical LAA exclusion techniques (resection, ligation, staples, clips).
- Discussion of percutaneous epicardial LAA ligation.
- Analysis of existing literature on LAA exclusion efficacy.
Main Results:
- Surgical LAA exclusion is a long-standing and established procedure.
- Multiple surgical and percutaneous techniques exist for LAA exclusion.
- Epicardial exclusion impacts LAA thrombus, electrical activity, and neuroendocrine balance.
Conclusions:
- Epicardial LAA exclusion addresses critical LAA-related complications.
- A variety of effective exclusion methods are available.
- Further understanding of LAA exclusion benefits is warranted.
Abstract:
Left atrial appendage (LAA) epicardial exclusion has been associated with addressing 2 potential deleterious consequences attributed to the LAA, namely, thrombus formation and an arrhythmogenic contributor in advanced forms of atrial fibrillation. With more than 60 years of history, the surgical exclusion of the LAA has been firmly established. Numerous approaches have been used for surgical LAA exclusion including surgical resections, suture ligation, cutting and non-cutting staples, and surgical clips. Additionally, a percutaneous epicardial LAA ligation approach has been developed. A discussion of the various epicardial LAA exclusion approaches and their efficacy will be discussed, along with the salient beneficial affects on LAA thrombus formation, LAA electrical isolation and neuroendocrine homeostasis.
