Percutaneous epicardial approach for LAA ligation
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Percutaneous epicardial approach for LAA ligation José M. Sanchez 1 & Adam Lee 2 & Krzysztof Bartus 3 & Randall J. Lee 2,4 Received: 2 May 2020 / Accepted: 29 September 2020 # Springer Science+Business Media, LLC, part of Springer Nature 2020
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. Keywords Left atrial appendage . Suture ligation . Epicardial . Atrial fibrillation . Stroke
1 Introduction Atrial fibrillation (AF) is the most common cardiac arrhythmia affecting more than 34 million people worldwide. AF is the leading cause of stroke, and independently increases the risk of developing end-stage renal disease, dementia, and Electronic supplementary material The online version of this article (https://doi.org/10.1007/s10840-020-00894-9) contains supplementary material, which is available to authorized users. * Randall J. Lee [email protected] 1
Section of Cardiac Electrophysiology, Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
2
Section of Cardiac Electrophysiology, Division of Cardiology, University of California, San Francisco, CA, USA
3
Department of Cardiovascular Surgery and Transplantation, Jagiellonian University Medical College, John Paul II Hospital, Krakow, Poland
4
San Francisco, USA
myocardial infarction due to thromboemboli. The left atrial appendage (LAA) is the most common source of thrombus, and a recognized source of triggers that initiate and perpetuate AF [1, 2]. In those who are intolerant to oral antic
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