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First Gross Anatomical Description in Human of Left Atrial Appendage Involution After LARIAT Procedure LUIS MORA, M.D.,∗ FAISAL M. MERCHANT, M.D.,† DAVID B. DELURGIO, M.D.,† and MICHAEL H. HOSKINS, M.D.∗ From the ∗ Emory University Hospital; and †Emory University Hospital-Midtown, Atlanta, Georgia, USA
A 56-year-old man with a history of paroxysmal atrial fibrillation was referred for consideration of nonpharmacologic approaches to reduce stroke risk. He had been recently admitted to the hospital with an acute ischemic stroke thought to be cardioembolic in origin and had a history of prior traumatic subdural hematoma. Given the co-existence of a strong indication for stroke prophylaxis along with a high risk of recurrent intracranial bleeding he was referred for left atrial R appendage (LAA) exclusion with the LARIAT device (SentreHEART, Inc., Redwood City, CA, USA). Cardiac computed tomography performed in anticipation of the procedure showed suitable LAA anatomy. Baseline transesophageal echocardiogram (TEE) showed no evidence
J Cardiovasc Electrophysiol, Vol. 26, pp. 350-351, March 2015. Dr. DeLurgio reports participation on a research grant supported by Boston Scientific. Other authors: No disclosures. Address for correspondence: Michael H. Hoskins, M.D., Emory University Hospital, 1364 Clifton Road, NE, Atlanta, GA 30322, USA. Fax: 404-7124374; E-mail: [email protected] doi: 10.1111/jce.12574
R of LAA thrombus (Fig. 1, Panel A). The LARIAT procedure was performed using the standard endocardial and epicardial approach that has been described previously. TEE performed after deployment of the LARIAT device showed complete LAA ligation, with no color Doppler flow in or out of the appendage (Fig. 1, Panel B). A follow-up TEE obtained 6 weeks after the procedure showed persistent and complete occlusion of the LAA. Approximately 7 months after the LARIAT procedure, the patient died from unrelated causes and an autopsy was performed. Representative pictures from the epicardial surface of his heart are shown (Fig. 1, Panels C and D). The solid arrow corresponds to the previous base of the LAA where the LARIAT suture was deployed. The LAA had involuted completely, with no remnant identified. A portion of the deployment end of the suture is seen adhered to the epicardial surface in this region (dashed arrow). The first clinical study with the LARIAT was performed in 2010. To our knowledge, the gross anatomical appearance of the LAA following exclusion with a LARIAT device in a human has not been reported previously. Whether these findings can be extrapolated to other cases of LARIAT LAA exclusion remains to be seen. Nonetheless, proof of the ability to percutaneously exclude the LAA as a source of thromboembolism in such an irreversible fashion is encouraging.
Mora et al.
Figure 1.
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This document is a scanned copy of a printed document. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material.
EP Image
First Gross Anatomical Description in Human of Left Atrial Appendage Involution After LARIAT Procedure LUIS MORA, M.D.,∗ FAISAL M. MERCHANT, M.D.,† DAVID B. DELURGIO, M.D.,† and MICHAEL H. HOSKINS, M.D.∗ From the ∗ Emory University Hospital; and †Emory University Hospital-Midtown, Atlanta, Georgia, USA
A 56-year-old man with a history of paroxysmal atrial fibrillation was referred for consideration of nonpharmacologic approaches to reduce stroke risk. He had been recently admitted to the hospital with an acute ischemic stroke thought to be cardioembolic in origin and had a history of prior traumatic subdural hematoma. Given the co-existence of a strong indication for stroke prophylaxis along with a high risk of recurrent intracranial bleeding he was referred for left atrial R appendage (LAA) exclusion with the LARIAT device (SentreHEART, Inc., Redwood City, CA, USA). Cardiac computed tomography performed in anticipation of the procedure showed suitable LAA anatomy. Baseline transesophageal echocardiogram (TEE) showed no evidence
J Cardiovasc Electrophysiol, Vol. 26, pp. 350-351, March 2015. Dr. DeLurgio reports participation on a research grant supported by Boston Scientific. Other authors: No disclosures. Address for correspondence: Michael H. Hoskins, M.D., Emory University Hospital, 1364 Clifton Road, NE, Atlanta, GA 30322, USA. Fax: 404-7124374; E-mail: [email protected] doi: 10.1111/jce.12574
R of LAA thrombus (Fig. 1, Panel A). The LARIAT procedure was performed using the standard endocardial and epicardial approach that has been described previously. TEE performed after deployment of the LARIAT device showed complete LAA ligation, with no color Doppler flow in or out of the appendage (Fig. 1, Panel B). A follow-up TEE obtained 6 weeks after the procedure showed persistent and complete occlusion of the LAA. Approximately 7 months after the LARIAT procedure, the patient died from unrelated causes and an autopsy was performed. Representative pictures from the epicardial surface of his heart are shown (Fig. 1, Panels C and D). The solid arrow corresponds to the previous base of the LAA where the LARIAT suture was deployed. The LAA had involuted completely, with no remnant identified. A portion of the deployment end of the suture is seen adhered to the epicardial surface in this region (dashed arrow). The first clinical study with the LARIAT was performed in 2010. To our knowledge, the gross anatomical appearance of the LAA following exclusion with a LARIAT device in a human has not been reported previously. Whether these findings can be extrapolated to other cases of LARIAT LAA exclusion remains to be seen. Nonetheless, proof of the ability to percutaneously exclude the LAA as a source of thromboembolism in such an irreversible fashion is encouraging.
Mora et al.
Figure 1.
EP Image
351
This document is a scanned copy of a printed document. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material.
