The low-profile LAmbre system facilitates ultrafast LAAO with direct vascular access and transseptal puncture via the device sheath

Aims: 
Different procedural strategies have been published targeting to facilitate transcatheter left atrial appendage occlusion  (LAAO). The LAmbre™ device has a lobe and disc design and can be delivered via 10F sheath. This low-profile allows the usage of the device sheath to (a) establish transfemoral venous access and (b) perform transseptal puncture with a radiofrequency (RF) wire, omitting several steps of a conventional LAAO procedure. We report safety and efficacy of this ultra-fast simplified interventional approach in unselected consecutive LAAO-patients.

Methods and results: 
We prospectively treated 16 patients (74 ± 10 years, 65% males) at an increased thromboembolic and bleeding risk (CHA₂DS₂VASC 4.0 ± 1.3; HAS-BLED 3.5 ± 0.9) with chronic renal failure (GFR 41 ± 21 ml/min) undergoing LAAO with the LAmbre system. All patients underwent procedural pre-planning with 3D transesophageal echocardiography (3DTOE) involving upfront LAA sizing and device selection. Direct femoral venous access with the 10F device sheath could be achieved in all patients. Septal steering capability of the double curve sheath was good, precise TSP by use of a dedicated RF wire was successful in all cases. Contrast free device implantation was performed under conscious sedation with TOE guidance. This simplified approach was associated with low radiation exposure (725±221 cGy*cm2), low fluoroscopy time (3.1 ± 2.1 min) and low overall procedure time (skin-to-skin, 15.5±6 min). Procedural success rates were excellent (100%) without relevant periprocedural complications (procedural death, stroke/systemic embolism, myocardial infarction, cardiac tamponade or major bleeding).

Conclusions: 
Simplified ultra-fast LAAO with direct venous access and TSP via a low-profile device sheath appears safe and feasible. 3D procedural pre-planning omits the use of contrast dye and facilitates this streamlined approach, which appears to be an alternative to traditional LAAO techniques increasing cathlab capacities.