5 Year follow up after epicardial ligation of the left atrial appendage

Karin Nentwich (Bad Neustadt a. d. Saale)1, E. Ene (Bad Neustadt a. d. Saale)1, A. Berkovitz (Bad Neustadt a. d. Saale)1, L. Randell (San Francisco)2, S. Kerber (Bad Neustadt a. d. Saale)3, S. Barth (Bad Neustadt a. d. Saale)3, T. Deneke (Bad Neustadt a. d. Saale)1

1RHÖN-KLINIKUM AG Campus Bad Neustadt Klinik für Kardiologie II / Interventionelle Elektrophysiologie Bad Neustadt a. d. Saale, Deutschland; 2University Section cardiac electrophysiology, Division Cardiology San Francisco, USA; 3RHÖN-KLINIKUM AG Campus Bad Neustadt Kardiologie Bad Neustadt a. d. Saale, Deutschland



Occlusion of the left atrial appendage (LAA) is an established indication for patients with contraindications for anticoagulation in atrial fibrillation and high stroke risk. Multiple trials have proven non inferiority of endocardial LAA occlusion in terms of embolic events versus oral anticoagulation. In our center LAA ligation using the Lariat device is the primary technique for occlusion as no long-term antithrombotic medication is used. Long-term safety and efficacy of epicardial ligation remains unclear. We present follow-up data on 5 years of all our patients undergoing the LARIAT procedure.



125 patients out of 211 screened patients were eligible for epicardial ligation in between Dezember 2015 and August 2023. LAA ligation using the LARIAT system was successful in 117 pts (93%). 1 severe procedural complication of LAA laceration with surgical occlusion of the LAA was recorded. Follow up (FUP) with transesophageal echo was planned for 6 weeks, 12 weeks and 12 months. Clinical FUP (death, embolic event, readministration of anticoagulation) was performed every 12 months. All data were documented and analyzed.



Mean age was 74,3 years, mean CHADSAVSC score 4, mean HASBLED score was 3,2. 6 weeks FUP was available in 92 patients, 12 weeks FUP in 66 patients and 12 months FUP in 40 patients. 6 patients developed pericarditis, 7 patients developed thrombus, 4 patients showed a gap of mean 2 mm. Lost to FUP were 7 patients, in 99 patients further clinical FUP was included. (mean 37,7 months ± 18). Of this cohort 20 patients died (6,7 % per year), 4 patients had an embolic event (1 peripheral embolic event, 3 strokes) and 13 patients were put on anticoagulation again. TEE was available in the chronic state in 74 patients with a mean time interval of 32 moths after ligation showing no late development of thrombus or gap.




Long-term follow-up of epicardial ligation of the LAA shows high efficacy and safety. No late ligation-associated complications were noted, 3% of patients had embolic events during follow-up.

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