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Percutaneous epicardial approach for LAA ligation

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Journal of Interventional Cardiac Electrophysiology Aims and scope Submit manuscript

Abstract

Purpose

The left atrial appendage (LAA) is believed to be a source for thrombus formation and an ancillary structure involved in the initiation and maintenance of atrial fibrillation (AF). LAA ligation has been proposed as adjunctive therapy for the treatment of AF. This study will determine the feasibility of a percutaneous epicardial approach for LAA ligation.

Methods

The pericardium of 5 dogs was accessed via percutaneous subxyphoid approach. A 20F epicardial cannula was inserted into the pericardial space and contrast-injected to visualize the LAA. Under fluoroscopic guidance, a suction cup catheter was inserted and attached to the LAA. A 12F snare device was inserted over the vacuum cup to ligate the LAA. The closure of the LAA was verified with LA angiography, in the first 2 dogs, and ICE in all 5 animals. All animals were sacrificed for post hoc assessment of LAA closure.

Results

All 5 dogs underwent successful epicardial suture ligation of the LAA. In the first 2 dogs, LA angiography demonstrated complete closure of the LAA. All dogs underwent gross examination of the LAA. Post hoc assessment was notable for a small well-circumscribed hematoma on the LAA, consistent with point of suction cup attachment, as well as complete closure of the entire LAA. No laceration or perforation was noted on the LAA.

Conclusions

Exclusion of the LAA via a novel percutaneous epicardial-only approach was successful without complications. This demonstrates the feasibility of this technique in an animal model, and may provide an effective approach for epicardial-only LAA exclusion in humans.

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Authors and Affiliations

  1. Section of Cardiac Electrophysiology, Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA

    José M. Sanchez

  2. Section of Cardiac Electrophysiology, Division of Cardiology, University of California, San Francisco, CA, USA

    Adam Lee & Randall J. Lee

  3. Department of Cardiovascular Surgery and Transplantation, Jagiellonian University Medical College, John Paul II Hospital, Krakow, Poland

    Krzysztof Bartus

  4. San Francisco, USA

    Randall J. Lee

Authors
  1. José M. Sanchez
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  2. Adam Lee
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  4. Randall J. Lee
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Corresponding author

Correspondence to Randall J. Lee.

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Conflict of interest

RJ Lee is a consultant and equity holder of SentreHEART/AtriCure, Inc. K. Bartus is a consultant of SentreHEART/AtriCure, Inc.

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Sanchez, J.M., Lee, A., Bartus, K. et al. Percutaneous epicardial approach for LAA ligation. J Interv Card Electrophysiol 62, 293–297 (2021). https://doi.org/10.1007/s10840-020-00894-9

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  • DOI: https://doi.org/10.1007/s10840-020-00894-9

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