Clinical Implications of Leaks Following Left Atrial Appendage Ligation with the LARIAT Device

Carola Gianni, Luigi Di Biase, Chintan Trivedi, Sanghamitra Mohanty, Yalçin Gökoǧlan, Mahmut F. Güneş, Rong Bai, Amin Al-Ahmad, J. David Burkhardt, Rodney P. Horton, Andrew K. Krumerman, Eugen C. Palma, Miguel Valderrábano, Douglas Gibson, Matthew J. Price, Andrea Natale

Research output: Contribution to journalArticle

28 Scopus citations

Abstract

Objectives The aim of this study was to evaluate the incidence and clinical implications of leaks (acute incomplete occlusion, early and late reopenings) following LAA ligation with the LARIAT device. Background Percutaneous LAA ligation with the LARIAT device may represent an alternative for stroke prevention in high-risk patients with atrial fibrillation with contraindications to oral anticoagulation. Methods This was a retrospective, multicenter study of 98 consecutive patients undergoing successful LAA ligation with the LARIAT device. Leaks were defined as the presence of flow as evaluated by transesophageal echocardiography (TEE). TEE was performed during the procedure, at 6 and 12 months, and after thromboembolic events. Results Leaks were detected in 5 (5%), 14 (15%), and 19 (20%) patients at the 3 time points. During follow-up, 5 patients developed neurological events (4 strokes and 1 transient ischemic attack). Two occurred early (1 fatal stroke and 1 stroke with multiple recurrences in the following months), and TEE was not repeated after the events. The remaining 3 occurred late (after 6 months) and were associated with small leaks (<5 mm). In 2 of 3 cases, such a small leak was missed by the standard evaluation on 2-dimensional TEE, being evident only with the aid of 3-dimensional imaging. Conclusions Incomplete occlusion of the LAA after LARIAT ligation is relatively common and may be associated with thromboembolic events. Proper long-term surveillance with careful TEE should be considered to detect leaks, which can be managed with either resumption of oral anticoagulation or percutaneous transcatheter closure.

Original languageEnglish (US)
Pages (from-to)1051-1057
Number of pages7
JournalJACC: Cardiovascular Interventions
Volume9
Issue number10
DOIs
StatePublished - May 23 2016

Keywords

  • 3D imaging
  • atrial fibrillation
  • leak
  • left atrial appendage
  • percutaneous intervention
  • stroke prevention

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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    Gianni, C., Di Biase, L., Trivedi, C., Mohanty, S., Gökoǧlan, Y., Güneş, M. F., Bai, R., Al-Ahmad, A., Burkhardt, J. D., Horton, R. P., Krumerman, A. K., Palma, E. C., Valderrábano, M., Gibson, D., Price, M. J., & Natale, A. (2016). Clinical Implications of Leaks Following Left Atrial Appendage Ligation with the LARIAT Device. JACC: Cardiovascular Interventions, 9(10), 1051-1057. https://doi.org/10.1016/j.jcin.2016.01.038