Key result
In a cumulative review of 334 patients, the LARIAT device achieved a 94% procedural success rate for left atrial appendage ligation, though procedural adverse events occurred in 14.7% of cases.
The LARIAT device offers a unique epicardial approach to percutaneous LAA ligation, but further data on safety and efficacy are required before it becomes an established therapy for stroke prevention in AF.
May warrant caution with LARIAT due to adverse events; leaves open need for randomized safety and efficacy data.
Atrial fibrillation (AF) is the most common arrhythmic disorder world-wide, accounting for 15 % of all strokes. Management of stroke risk in AF is complicated by intolerance of anti-coagulation (AC) therapy and difficulty maintaining therapeutic range in patients treated with warfarin. The left atrial appendage (LAA) is a source of thrombus in AFrelated thrombo-embolic events and surgical LAA exclusion (LAAO) is commonly performed during cardiac surgery in AF patients. Surgical approaches are limited by a high incidence of incomplete closure with a potential for consequent thrombo-embolic events as well as the morbidity of an open-heart procedure. More recently, percutaneous approaches to LAAO have been developed. The LARIAT device is an epicardial LAA exclusion system that enables percutaneous suture ligation of the LAA via combined, pericardial and trans-septal access. The device has 510k Federal Drug Administration (FDA) clearance for soft-tissue ligation and has been studied in canine models in pre-clinical studies as well as published series of clinical experience with LARIAT LAAO. The history, patient selection, procedural technique and complications of LARIAT LAAO are reviewed here. Additionally, insights and procedural improvements that have been elucidated from clinical series and outcomes from the collective experience are discussed. The LARIAT's epicardial approach to LAA ligation is unique compared with other percutaneous LAA exclusion devices, however more data regarding device safety and efficacy is needed for the LARIAT to emerge as an established therapy for stroke prevention in AF.
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Srivastava et al. (2015) conducted a review in Atrial fibrillation (n=334). LARIAT device was evaluated on Device success (successful deployment with <5 mm leak). In a cumulative review of 334 patients, the LARIAT device achieved a 94% procedural success rate for left atrial appendage ligation, though procedural adverse events occurred in 14.7% of cases.
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