Anatomic Analysis of the Left Atrial Appendage After Closure With the LARIAT Device
The pathophysiologic role of the left atrial appendage (LAA) in thromboembolic disease and as the primary source for cardioembolic events in patients with atrial fibrillation (AF) has been recognized since the 1950s.1 This has led to the development of percutaneous approaches to exclude LAA, including LAA ligation with the LARIAT suture delivery device (SentreHEART, Inc, Redwood City, CA).2 However, the anatomic consequences of percutaneous LAA ligation are unknown. This report describes LAA gross anatomy and histological consequences of LAA ligation from 2 patients.
A 63-year-old man with a history of persistent AF on chronic warfarin oral anticoagulation was referred for LAA exclusion after severe gastrointestinal bleeding and history of falling resulting in a hip fracture. His past medical history included hypertension, diabetes mellitus, previous myocardial infarctions, congestive heart failure, end-stage renal disease on hemodialysis, peripheral vascular disease, status post–femoral popliteal bypass surgery, and hip fracture. The patient had a CHADS2 score of 3, CHADS-Vasc score of 4, and a HAS-Bleed score of 4. The patient underwent an uncomplicated closed-chested LAA ligation with the LARIAT suture delivery device.2 LAA closure was confirmed with transesophageal echocardiography (TEE) and contrast fluoroscopy acutely (Figure 1). The patient did well post-LAA closure and was on no antiplatelet or antithrombin medications. A follow-up TEE performed at 8 months revealed a closed LAA with no leaks. Eleven months after his LAA ligation, the patient was admitted to the hospital with pneumonia and volume-overloaded congestive heart failure. During dialysis, the patient had a ventricular fibrillation arrest. Cardiac resuscitation was initiated but was unsuccessful and the patient …