Author + information
- Sunil P. Singh,
- Lucas Zier,
- Nitish Badhwar,
- Randall Lee and
- Vaikom Mahadevan
Background: Device closure of the left atrial appendage (LAA) is widely used for patients unsuitable for anticoagulation. The Lariat device (SentreHEART, Redwood City, CA) is a percutaneous suture based device currently approved for percutaneous LAA ligation. While greater than 90% of patients who undergo the Lariat procedure have no residual flow in the LAA, a small proportion can have significant (3-5 mm) leaks. The thromboembolic risk of a residual leak remains unclear. The aim of this study was to evaluate the safety and efficacy of the Amplatzer vascular plug (AVPII, St. Jude Medical, St. Paul, MN) in the closure of residual LAA leak after LAA ligation using the Lariat device.
Methods: Here we report the outcomes of four patients with significant residual leaks who underwent device closure. Four patients, all male, mean age 75 ± 10.6 years with residual LAA leak diameter ranging between 3.5 to 6mm as assessed by transesophageal echocardiogram (TEE), underwent device closure using the AVPII. Transseptal access was obtained through a femoral venous approach using a NTG RF transseptal needle (Baylis Medical, Montreal, Canada). Contrast injection into the left atrium with a 5F straight pigtail catheter confirmed the residual LAA leak. A 6F multipurpose guide catheter was positioned in the LAA leak over a glide wire followed by deployment of an AVPII device (6 or 8mm).
Results: All cases resulted in complete cessation of residual LAA flow after device deployment as confirmed by TEE and angiography. Three patients required one AVPII device and one patient required two 8mm AVPII devices. There were no procedural complications. At a median follow-up period of 369 days, anticoagulation was discontinued in two of four patients (the other two remain on anticoagulation pending further ablation). One patient reverted to sinus rhythm from persistent atrial fibrillation following residual leak closure.
Conclusions: Percutaneous management of LAA leak following Lariat closure using the AVPII device is safe, efficacious, and potentially permits discontinuation of anticoagulation mitigating bleeding risk. It should be considered in patients with a residual LAA leak.
Poster Hall, Hall C
Saturday, March 18, 2017, 9:45 a.m.-10:30 a.m.
Session Title: Arrhythmias and Clinical EP: Devices 3
Abstract Category: 5. Arrhythmias and Clinical EP: Devices
Presentation Number: 1188-078
- 2017 American College of Cardiology Foundation