Percutaneous LAA ligation (Lariat) - Dr. Himanshu Agarwal
Atrial fibrillation is the most common arrhythmia encountered in clinical practice, affecting approximately 1% of all patients. Atrial fibrillation puts patients at risk for developing blood clots that can lead to strokes. Anticoagulants or blood thinners can help prevent strokes, but there is still a risk of developing clots in the left atrial appendage. Closing the left atrial appendage can greatly reduce the risk of developing clots and reduces the use of anticoagulants and bleeding complications.
How do we treat this condition?
The left atrial appendage closure procedure involves inserting a catheter into the chest and carefully puncturing the sac around the heart, called the pericardium. A magnet-tipped wire is advanced through the catheter until it touches the tip of the outside of the finger-shaped left atrial appendage. Another wire is inserted through the femoral artery in the groin and threaded up into the heart and into the left atrial appendage. The two magnets – one inside the tip of the left atrial appendage, one on its surface – snap together, and their attached wires form a “guide rail” which holds the appendage steady, even while the heart continues to beat.
The LARIAT® snare is made of polyester surgical thread and shaped like a lasso with a slipknot tied at the end. It is slid along the guide rail to the base of the appendage. Because the doctor cannot see the left atrial appendage directly, he or she uses x-ray fluoroscopy to assist in the inflation of a balloon catheter inside the appendage. The slipknot is tightened, the balloon is deflated and removed, and the LARIAT® snare is cinched tight to completely close off the appendage. A thread cutter snips off the excess thread near the knot. Once all the equipment is removed, all that remains in the body is the tiny slipknot.
Who would benefit?
Candidates for left atrial appendage closure procedure (Lariat) are patients with atrial fibrillation who:
have had bleeding that cannot be managed, such as gastrointestinal bleed;
have experienced a stroke despite anticoagulation therapy;
are elderly/frail and at high risk for anticoagulation due to the risk of falls and bleeding complications.
People who have had open heart surgery are not eligible for the Lariat Suture due to the likelihood of scar tissue on the pericardium.
What are the risks and prognosis for the patient with this condition?
The prognosis is good is for patients who undergo the left atrial appendage closure procedure. Unlike other procedures, anticoagulants are not needed post-operatively. There is a risk of pericarditis or inflammation of the heart. This can be treated with non-steroidal anti-inflammatory medications such as ibuprofen.