The SIMPLE registry: SIMplified approach for percutaneous LAA Exclusion

Percutaneous epicardial left atrial appendage (LAA) ligation requires a series of steps and ancillary tools and is thus perceived as complex.

In this report, we evaluate the feasibility, safety, and effectiveness of a modified approach for LAA ligation.

This is a retrospective multicenter collection of patients who underwent a modified LAA ligation approach. Using only a pigtail LAA angiogram, the LARIAT snare was guided over the pigtail catheter to perform LAA ligation. Periprocedural and 30-day adverse events were collected. Follow-up imaging was performed 6 weeks‒3 months post ligation to assess for leaks.

Overall, 21 centers enrolled 104 patients (aged 71.7 ± 7.2 years; 70% male) who underwent attempted modified LAA ligation. Short-term complete LAA closure was achieved in 96.8% of patients (91/94). LAA ligation failed in 8 patients owing to adhesions. In 2 patients, ligations could not be performed with the modified pigtail approach and were converted to magnet wires, with 1 successful and 1 unsuccessful LAA ligation. The failed LAA ligation was due to a perforation of the magnet wires. There were no periprocedural complications (<7 days). In 3 patients, a delayed inflammatory pericardial effusion developed requiring pericardiocentesis, but 2 of these also underwent combined ablation. Among patients with follow-up imaging (90/104), complete LAA closure was achieved in 95.5% (86/90), and no leaks >3 mm were observed.

The evolution of the pigtail-only modified LAA ligation approach is feasible, safe, and effective at LAA closure. Future studies are still needed to assess the long-term LAA closure efficacy of this modified LAA ligation approach.