Surgical ligation of the left atrial appendage (LAA) has been shown to be an effective alternative to warfarin therapy in patients with atrial fibrillation. A novel catheter-based approach for LAA ligation was evaluated for safety and effectiveness in a canine model.
A total of 26 healthy mongrel dogs underwent ligation of the LAA through a catheter-based approach. Intracardiac echocardiography and contrast fluoroscopy were used to position a marker balloon at the origin of the LAA. An over-the-wire approach was used to guide the LARIAT snare device over the LAA to enable ligation of the LAA. Sixteen dogs were euthanized acutely. The LAA was examined to assess the placement and completeness of the ligation. The remaining 10 dogs were used for long-term follow-up. The snare delivery device was able to completely capture, advance, and close the anatomic base of the LAA in all cases. In all animals, complete LAA exclusion through this closed-chest approach was achieved without complications. Chronic follow-up revealed healthy active dogs. Examination of the LAA at 7 days, 1 month, and 3 months demonstrated completely endothelialized orifice of the LAA.
Using a closed-chest approach in the canine model, the catheter-based snare delivery device achieved safe and reliable ligation of the entire LAA. The clinical application of this novel approach may provide an alternative to warfarin or to permanent device implants in patients with nonvalvular atrial fibrillation for the prevention of embolic events originating from the LAA.
"The feasibility of the mentioned Lariat non-surgical combined endocardial/epicardial suture ligation of the LAA was first demonstrated in animals by Lee et al. in 2010, 46 then in humans by Bartus et al. 47 in 2011, and subsequently evaluated in clinical routine. The device has CE mark and is approved by the FDA. "
"Initial experience in a canine model has confirmed the safety and feasibility of the LARIAT system . In the first human experience, ten patients successfully underwent LAA exclusion with the LARIAT suture, one of whom required thorascopic removal of the snare owing to pectus excavatum . "
[Show abstract][Hide abstract] ABSTRACT: The public health burden of atrial fibrillation (AF) and associated thromboembolic stroke continues to grow at alarming rates. AF leads to a fivefold increase in the risk of stroke. Therefore, stroke prevention remains the most critical aspect of AF management. Current standard of care focuses on oral systemic anticoagulation, most commonly with warfarin and now with newer agents such as dabigatran, rivaroxaban, and apixaban. However, the challenges and limitations of oral anticoagulation have been well documented. Given the critical role of the left atrial appendage (LAA) in the genesis of AF-related thromboembolism, recent efforts have targeted removal or occlusion of the LAA as an alternative strategy for stroke prevention, particularly in patients deemed unsuitable for oral anticoagulation. This paper highlights recent advances in mechanical exclusion of the LAA. The problem of AF and stroke is briefly summarized, followed by an explanation for the rationale behind LAA exclusion for stroke prevention. After briefly reviewing the history of LAA exclusion, we highlight the most promising LAA exclusion devices currently available. Finally, we discuss future challenges and opportunities in this growing field.
Cardiology Research and Practice 10/2012; 2012(1):610827. DOI:10.1155/2012/610827
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