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Published on: February 26, 2013
Simultaneous Endocardial and Epicardial Approach for Successful Closure of Left Atrial Appendage With Difficult
Aashish Katapadi1, Rakesh Gopinathannair1, Naga Venkata K Pothineni1
1Kansas City Heart Rhythm Institute, Overland Park, Kansas, USA.
Insights
Left atrial appendage closure (LAAC) effectively prevents stroke. Challenging anatomy requires both endocardial and epicardial approaches for successful LAAC outcomes.
Area of Science:
- Cardiology
- Interventional Cardiology
- Medical Devices
Background:
- Left atrial appendage closure (LAAC) is a key stroke prevention strategy in atrial fibrillation.
- Complex left atrial appendage (LAA) anatomy presents significant procedural challenges for LAAC.
Observation:
- A patient with paroxysmal atrial fibrillation and recurrent falls presented for LAAC.
- Preoperative imaging revealed challenging LAA anatomy.
- Initial endocardial LAAC attempts were unsuccessful.
Findings:
- Epicardial access was obtained, and LAAC was successfully completed using an epicardial device.
- This case demonstrates the successful application of an epicardial strategy for LAAC in complex anatomy.
Implications:
- Preprocedural imaging is crucial for identifying challenging LAA anatomy and guiding procedural planning.
- An upfront epicardial access strategy provides an immediate alternative for LAAC when endocardial approaches fail.
- Integrating both endocardial and epicardial LAAC techniques is vital for comprehensive stroke prevention programs.
Background:
Left atrial appendage closure (LAAC) is increasingly used for stroke prevention; however, left atrial appendage (LAA) anatomy may pose significant challenges.
Case Summary:
A 67-year-old man with paroxysmal atrial fibrillation, CHA2DS2-VASc Score of 3, and recurrent falls was referred for LAAC. Owing to challenging anatomy noted during preoperative imaging, epicardial access was obtained at procedure onset. Following multiple unsuccessful endocardial attempts, LAAC was successfully achieved by an epicardial device.
Discussion:
Preprocedural imaging can identify challenging LAA anatomy and assist in procedural planning. In patients with challenging LAA anatomy, obtaining epicardial access up front before endocardial closure attempts offers an additional immediate option in case of failure. This case highlights the importance and use of both endocardial and epicardial LAAC strategies for a comprehensive LAAC program.
Take-Home Message:
We demonstrate that a methodological approach with preprocedural LAA imaging and endocardial and epicardial LAAC strategies results in successful clinical outcomes.
