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Lariat procedure

Zeena Husain, Payam Safavi-Naeini, Abdi Rasekh, Mehdi Razavi, Charles D Collard, James M Anton, Daniel A Tolpin
Atrial fibrillation is the most common cardiac arrhythmia in adults affecting almost 6 million adults in the United States. The 2 most common comorbidities associated with atrial fibrillation are heart failure and thromboembolic events. Heart failure symptoms may be treated with rate control, antiarrhythmic medications or by catheter ablation. Unfortunately, despite optimal medical management, thromboembolic events still occur. Recently, there has been a great deal of interest and innovation in finding an alternative to chronic anticoagulation...
June 1, 2017: Seminars in Cardiothoracic and Vascular Anesthesia
Arijit Chanda, John P Reilly
More than 2.3 million adults in the United States have atrial fibrillation (AF), which exposes them to a 5-fold increased risk of stroke. The left atrial appendage (LAA) appears to be the source of thrombus formation in the vast majority of these patients. Anticoagulation significantly reduces the risk of stroke, but often we encounter patients who have absolute or relative contraindication to anticoagulation. Percutaneous LAA exclusion offers an alternative to anticoagulation to decrease the risk of stroke...
May 2017: Progress in Cardiovascular Diseases
K Bartus, J Podolec, R J Lee, B Kapelak, J Sadowski, M Bartus, K Oles, P Ceranowicz, R Trabka, R Litwinowicz
Percutaneous left atrial appendage closure is an alternative treatment for stroke and systemic thromboembolism risk reduction in non-valvular atrial fibrillation (AF). However, the neurohormonal impact of epicardial exclusion of the left atrial appendage (LAA) with the LARIAT procedure is unknown. Evaluation of changes in atrial natriuretic peptide (ANP) and brain natriuretic peptide (BNP) levels in AF patients underwent percutaneous LAA suture ligation. Sixty six patients underwent successfully percutaneous LAA suture ligation using LARIAT device...
February 2017: Journal of Physiology and Pharmacology: An Official Journal of the Polish Physiological Society
Timothy R Betts, Milena Leo, Sandeep Panikker, Prapa Kanagaratnam, Michael Koa-Wing, David Wyn Davies, David Hildick-Smith, Dylan G Wynne, Oliver Ormerod, Oliver R Segal, Anthony W Chow, Derick Todd, Sandra Cabrera Gomez, Graeme J Kirkwood, David Fox, Chris Pepper, John Foran, Tom Wong
OBJECTIVES: This study aimed at assessing the feasibility and long-term efficacy of left atrial appendage occlusion (LAAO) in a "real world" setting. BACKGROUND: Although LAAO has recently emerged as an alternative to oral anticoagulants in patients with atrial fibrillation for the prevention of thromboembolic stroke, "real world" data about the procedure with different devices are lacking. METHODS: Eight centers in the United Kingdom contributed to a retrospective registry for LAAO procedures undertaken between July 2009 and November 2014...
February 15, 2017: Catheterization and Cardiovascular Interventions
Carola Gianni, Luigi Di Biase, Chintan Trivedi, Sanghamitra Mohanty, Yalçın Gökoğlan, Mahmut F Güneş, Rong Bai, Amin Al-Ahmad, J David Burkhardt, Rodney P Horton, Andrew K Krumerman, Eugen C Palma, Miguel Valderrábano, Douglas Gibson, Matthew J Price, Andrea Natale
OBJECTIVES: The aim of this study was to evaluate the incidence and clinical implications of leaks (acute incomplete occlusion, early and late reopenings) following LAA ligation with the LARIAT device. BACKGROUND: Percutaneous LAA ligation with the LARIAT device may represent an alternative for stroke prevention in high-risk patients with atrial fibrillation with contraindications to oral anticoagulation. METHODS: This was a retrospective, multicenter study of 98 consecutive patients undergoing successful LAA ligation with the LARIAT device...
May 23, 2016: JACC. Cardiovascular Interventions
Krzysztof Bartus, Sameer Gafoor, David Tschopp, John P Foran, Roland Tilz, Tom Wong, Dhanunjaya Lakkireddy, Horst Sievert, Randall J Lee
BACKGROUND: The purpose of the study was to determine the efficacy and safety of left atrial appendage (LAA) closure with a micropuncture pericardial access approach and the new LARIAT(+) suture delivery device. METHODS: Seventy-two patients with atrial fibrillation were enrolled to undergo telescopic micropuncture pericardial access and percutaneous ligation of the LAA with the LARIAT(+) device. LAA closure was confirmed with transesophageal echocardiography (TEE) and contrast fluoroscopy immediately, then with TEE at 30days and 90days post-LAA ligation...
July 15, 2016: International Journal of Cardiology
Dhanunjaya Lakkireddy, Muhammad R Afzal, Randall J Lee, Hosakote Nagaraj, David Tschopp, Brett Gidney, Christopher Ellis, Eric Altman, Brian Lee, Saibal Kar, Nitish Bhadwar, Mauricio Sanchez, Varuna Gadiyaram, Rudolph Evonich, Abdi Rasekh, Jie Cheng, Frank Cuoco, Sheetal Chandhok, Sampath Gunda, Madhu Reddy, Donita Atkins, Sudharani Bommana, Phillip Cuculich, Douglas Gibson, Jayant Nath, Ryan Ferrell, Earnest Matthew, David Wilber
BACKGROUND: Published studies of epicardial ligation of left atrial appendage (LAA) have reported discordant results. OBJECTIVE: The purpose of this study was to delineate the safety and efficacy of LAA closure with the LARIAT device. METHODS: This is a multicenter registry of 712 consecutive patients undergoing LAA ligation with LARIAT at 18 US hospitals. The primary end point was successful suture deployment, no leak by intraprocedural transesophageal echocardiography (TEE), and no major complication (death, stroke, cardiac perforation, and bleeding requiring transfusion) at discharge...
May 2016: Heart Rhythm: the Official Journal of the Heart Rhythm Society
Julius Toeri, Marie-Pierre Laborie
In this study an efficient and direct production procedure for a macrocyclic polyether N,N'-diallyl-7,16-diaza-1,4,10,13-tetraoxa-dibenzo-18-crown-6 from the reaction of catechol and N,N-bis(2-chloroethyl)prop-2-en-1-amine in n-butanol in the presence of a strong base is reported. The synthesis involves a two-step addition of sodium hydroxide to enhance the cyclization process, and at the end of the reaction, the reaction mixture is neutralized and the solvent replaced with water in-situ through distillation to afford a relatively pure precipitate that is easily recrystallized from acetone...
January 29, 2016: Molecules: a Journal of Synthetic Chemistry and Natural Product Chemistry
Randall J Lee, Dhanunjaya Lakkireddy, Suneet Mittal, Christopher Ellis, Jason T Connor, Benjamin R Saville, David Wilber
BACKGROUND: Pulmonary vein antrum isolation (PVI) as a treatment of paroxysmal atrial fibrillation (AF) is associated with a high rate of success; however, outcomes for treating persistent and long-standing persistent AF with PVI alone are substantially lower and often require multiple procedures to maintain long-term freedom from atrial arrhythmias. Foci and/or substrate outside the pulmonary veins, particularly in the left atrial appendage (LAA), has been identified as a key mechanism in the maintenance of persistent AF and long-standing persistent AF...
December 2015: American Heart Journal
Bahij Kreidieh, Francia Rojas, Paul Schurmann, Amish S Dave, Amir Kashani, Moisés Rodríguez-Mañero, Miguel Valderrábano
BACKGROUND: Left atrial appendage (LAA) ligation with the Lariat device is being used for stroke prevention in atrial fibrillation. Residual leaks into the LAA are commonly reported after the procedure. Little is known about the anatomic LAA remodeling after Lariat ligation. METHODS AND RESULTS: In an exploratory study, we evaluated LAA 3-dimensional geometry via computed tomographic scan in 31 consecutive patients before Lariat closure and after a minimum of 30 days post procedure...
December 2015: Circulation. Arrhythmia and Electrophysiology
Mukta C Srivastava, Vincent Y See, Murtaza Y Dawood, Matthew J Price
Atrial fibrillation (AF) is the most common arrhythmic disorder world-wide, accounting for 15 % of all strokes. Management of stroke risk in AF is complicated by intolerance of anti-coagulation (AC) therapy and difficulty maintaining therapeutic range in patients treated with warfarin. The left atrial appendage (LAA) is a source of thrombus in AFrelated thrombo-embolic events and surgical LAA exclusion (LAAO) is commonly performed during cardiac surgery in AF patients. Surgical approaches are limited by a high incidence of incomplete closure with a potential for consequent thrombo-embolic events as well as the morbidity of an open-heart procedure...
2015: SpringerPlus
Basel Ramlawi, Walid K Abu Saleh, James Edgerton
A patient with atrial fibrillation (AF) has a greater than 5% annual risk of major stroke, a 5-fold increase compared to the general population. While anticoagulation remains the standard stroke prevention strategy, the nature of lifelong anticoagulation inevitably carries an increased risk of bleeding, increased stroke during periods of interruption, increased cost, and significant lifestyle modification. Many patients with atrial fibrillation have had their left atrial appendage (LAA) ligated or excised by surgeons during cardiac surgery, a decision based largely on intuition and with no clear evidence of efficacy in stroke risk reduction...
April 2015: Methodist DeBakey Cardiovascular Journal
Sampath Gunda, Madhu Reddy, Jayasree Pillarisetti, Moustapha Atoui, Nitish Badhwar, Vijay Swarup, Luigi DiBiase, Sanghamitra Mohanty, Prashanth Mohanty, Hosakote Nagaraj, Christopher Ellis, Abdi Rasekh, Jie Cheng, Krzysztof Bartus, Randall Lee, Andrea Natale, Dhanunjaya Lakkireddy
BACKGROUND: A dry epicardial access (EA) is increasingly used for advanced cardiovascular procedures. Conventionally used large bore needles (Tuohy or Pajunk needle; LBN) have been associated with low but definite incidence of major complications with EA. Use of micropuncture needle (MPN) may decrease the risk of complications. We intended to compare the outcomes of LBN with MPN for EA. METHODS AND RESULTS: We report a multicenter observational study of consecutive patients who underwent EA for ventricular tachycardia ablation or Lariat procedure using the LBN or MPN...
August 2015: Circulation. Arrhythmia and Electrophysiology
Krishan Soni, Manoj Kesarwani, Nitish Badhwar, Vaikom S Mahadevan
No abstract text is available yet for this article.
June 2015: JACC. Cardiovascular Interventions
Ryan Maybrook, Jayasree Pillarisetti, Vivek Yarlagadda, Sampath Gunda, Arun Raghav Mahankali Sridhar, Brent Deibert, Muhammad R Afzal, Madhu Reddy, Donita Atkins, Matthew Earnest, Ryan Ferrell, Jayant Nath, Arun Kanmanthareddy, Sudharani Bommana, Rajasingh Johnson, Sandeep Reddy Koripalli, Buddhadeb Dawn, Dhanunjaya Lakkireddy
PURPOSE: The left atrial appendage (LAA) is a well-known source of atrial natriuretic peptide (ANP) and therefore plays an important role in homeostasis. The neurohormonal impact of epicardial exclusion of the LAA with the LARIAT procedure is unknown. In this proof-of-concept study, we postulated that LAA exclusion would impact homeostasis as evidenced by changes in electrolytes and blood pressure (BP). METHODS: A total of 76 patients who underwent successful LAA exclusion were enrolled in this retrospective observational study utilizing a prospective registry...
September 2015: Journal of Interventional Cardiac Electrophysiology: An International Journal of Arrhythmias and Pacing
Paul D Varosy
No abstract text is available yet for this article.
July 2015: JAMA Internal Medicine
Saurav Chatterjee, Howard C Herrmann, Robert L Wilensky, John Hirshfeld, Daniel McCormick, David S Frankel, Robert W Yeh, Ehrin J Armstrong, Dharam J Kumbhani, Jay Giri
IMPORTANCE: The Lariat device has received US Food and Drug Administration (FDA) 510(k) clearance for soft-tissue approximation and is being widely used off-label for left atrial appendage (LAA) exclusion. A comprehensive analysis of safety and effectiveness has not been reported. OBJECTIVES: To perform a systematic review of published literature to assess safety and procedural success, defined as successful closure of the LAA during the index procedure, of the Lariat device...
July 2015: JAMA Internal Medicine
Jayasree Pillarisetti, Yeruva Madhu Reddy, Sampath Gunda, Vijay Swarup, Randall Lee, Abdi Rasekh, Rodney Horton, Ali Massumi, Jie Cheng, Krzystzof Bartus, Nitish Badhwar, Frederick Han, Donita Atkins, Sudharani Bommana, Matthew Earnest, Jayant Nath, Ryan Ferrell, Steven Bormann, Buddhadeb Dawn, Luigi Di Biase, Moussa Mansour, Andrea Natale, Dhanunjaya Lakkireddy
BACKGROUND: Watchman and Lariat left atrial appendage (LAA) occlusion devices are associated with LAA leaks postdeployment. OBJECTIVE: The purpose of this study was to compare the incidence, characteristics, and clinical significance of these leaks. METHODS: We performed a multicenter prospective observational study of all patients who underwent LAA closure. Baseline, procedural, and imaging variables along with LAA occlusion rates at 30-90 days and 1-year postprocedure were compared...
July 2015: Heart Rhythm: the Official Journal of the Heart Rhythm Society
Nitish Badhwar, Dhanunjaya Lakkireddy, Mitsuharu Kawamura, Frederick T Han, Sivaraman K Iyer, Brian S Moyers, Thomas A Dewland, Chris Woods, Ryan Ferrell, Jayant Nath, Mathew Earnest, Randall J Lee
INTRODUCTION: Left atrial appendage (LAA) ligation results in LAA electrical isolation and a decrease in atrial fibrillation (AF) burden. This study assessed the feasibility of combined percutaneous LAA ligation and pulmonary vein isolation (PVI) in patients with persistent AF. METHODS AND RESULTS: A total of 22 patients with persistent AF underwent LAA ligation with the LARIAT device followed by PVI. PVI was confirmed with the demonstration of both entrance and exit block...
June 2015: Journal of Cardiovascular Electrophysiology
Sampath Gunda, Arun Kanmanthareddy, Ajay Vallakati, Pramod Janga, Muhammad Rizwan Afzal, Jayasree Pillarisetti, Sudharani Bommana, Donita Atkins, Matthew Earnest, Jayant Nath, Nagaraj Hosakote, Luigi DI Biase, Andrea Natale, Madhu Reddy, Randall Lee, Dhanunjaya Lakkireddy
BACKGROUND: The Lariat procedure is increasingly used for the exclusion of the left atrial appendage (LAA) in atrial fibrillation (AF) patients. There are anecdotal reports of pleural effusions after the Lariat procedure. However, the incidence, demographics, and pathophysiology of these effusions are largely unknown. OBJECTIVE: Characterization of pleural effusions in patients who underwent LAA exclusion using the Lariat procedure. METHODS: We report the incidence, demographics, and clinical and laboratory characteristics of patients from a multicenter prospective registry who underwent the Lariat procedure and subsequently developed pleural effusions...
May 2015: Journal of Cardiovascular Electrophysiology
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