Key result
Epicardial LARIAT closure achieves ~100% acute success for peridevice leaks after endocardial LAA closure.
Why the study?
Existing techniques to close clinically significant peri-device leaks after left atrial appendage occlusion each have limitations, and the initial feasibility of the LARIAT suture device as an alternative strategy needed evaluation.
Does epicardial LARIAT suture device closure achieve acute closure of clinically significant peri-device leaks (≥3 mm) in patients with prior endocardial left atrial appendage occlusion?
Observational
Yes
Does epicardial LARIAT suture device closure achieve acute closure of clinically significant peri-device leaks (≥3 mm) in patients with prior endocardial left atrial appendage occlusion?
Epicardial closure using the LARIAT suture device achieved 100% acute closure of clinically significant peri-device leaks (≥3 mm) following prior Watchman or Amulet endocardial LAA occlusion, offering a feasible alternative strategy.
May support adjunctive use for refractory leaks; leaves open long-term thromboembolic outcomes and safety in prospective trials.
BACKGROUND: 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. OBJECTIVE: We report the initial feasibility of LARIAT for endocardial LAA closure PDLs. METHODS: 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. 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. CONCLUSION: 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.
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Katapadi et al. (2026) conducted an observational in Peridevice leaks after endocardial left atrial appendage closure. LARIAT suture device was evaluated on Acute PDL closure (pericardial access with device deployment and elimination of the PDL on intraprocedural imaging) and 45-day safety. Epicardial LARIAT suture closure achieved 100% acute success in eliminating peridevice leaks ≥3 mm after endocardial LAA closure, with a mean procedural time of 48.7±10.8 minutes.
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