Epicardial Closure for Peridevice Leaks from Endocardial Left Atrial Appendage Closure - Early LARIAT-4-PDL Registry...

Closure of clinically significant peri-device leaks (PDLs) after left atrial appendage (LAA) occlusion remains crucial to prevent thromboembolism. A variety of techniques exist to close PDLs, each with its own advantages and disadvantages. The LARIAT (Atricure, Mason, OH) suture device may provide an alternative for closing PDLs.

We report the initial feasibility of LARIAT for endocardial LAA closure PDLs.

In a multicenter, retrospective study, we reviewed consecutive patients who underwent LARIAT for closure of device-related LAA leaks. All patients had PDLs ≥3 mm after either a Watchman FLX Pro (Boston Scientific, Marlborough, MA) or an Amplatzer Amulet (Abbott, Chicago, IL) endocardial LAA occluder, as seen on postoperative imaging. Acute PDL closure - pericardial access with device deployment and elimination of the PDL on intraprocedural imaging - was evaluated with either transesophageal or intracardiac echocardiogram, along with 45-day safety.

We report 10 cases in patients aged 67.2±10.7years, 30.0% female, and with a body mass index 32.4±6.4 kg/m². Baseline comorbidities included a CHADSVASC of 4.4±0.7 and HASBLED of 3.7±0.7. Initially, patients underwent Watchman (80.0%) or Amulet (20.0%) with an average PDL of 5.4±0.8 mm. Few cases had attempted PDL closure with radiofrequency ablation (10.0%), coiling (20.0%), or a previous device (10.0%). After procedural and fluoroscopy times of 48.7±10.8 min and 7.0±3.7 min, respectively, LARIAT PDL closure was successful in all cases, and no difference when stratified by initial endocardial LAA closure type.

These initial results suggest that a LARIAT may be an alternative strategy in patients with clinically significant PDLs after endocardial LAA closure. Future studies are needed to corroborate our initial findings and long-term closure results.