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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 long-standing surgical technique, effectively prevents thrombus formation and reduces arrhythmia triggers. Various epicardial methods, including surgical and percutaneous approaches, demonstrate significant benefits.
Area of Science:
- Cardiology
- Cardiac Surgery
- Electrophysiology
Background:
- The left atrial appendage (LAA) is implicated in thrombus formation and atrial fibrillation (AF) pathogenesis.
- Surgical LAA exclusion has a history spanning over 60 years.
Purpose of the Study:
- To discuss various epicardial LAA exclusion techniques.
- To evaluate the efficacy of these approaches in preventing LAA thrombus and mitigating AF.
Main Methods:
- Review of established surgical exclusion methods: resection, suture ligation, stapling, and clips.
- Discussion of the percutaneous epicardial LAA ligation approach.
Main Results:
- Epicardial LAA exclusion is effective in addressing thrombus formation.
- These techniques contribute to LAA electrical isolation, potentially benefiting AF patients.
Conclusions:
- Surgical and percutaneous epicardial LAA exclusion are established methods with significant benefits.
- Further discussion on efficacy regarding LAA thrombus, electrical isolation, and neuroendocrine homeostasis 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.
