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Lariat procedure

Tawseef Dar, Muhammad R Afzal, Bharath Yarlagadda, Shelby Kutty, Quanliang Shang, Sampath Gunda, Anweshan Samanta, Jahnavi Thummaluru, Kedareeshwar S Arukala, Arun Kanmanthareddy, Madhu Reddy, Donita Atkins, Sudharani Bommana, Buddhadeb Dawn, Dhanunjaya Lakkireddy
BACKGROUND: Left atrial (LA) strain (ε) and ε rate (SR) analysis by 2-dimensional speckle tracking echocardiography is a novel method for functional assessment of the LA. OBJECTIVE: The purpose of this study was to determine the impact of left atrial appendage (LAA) exclusion by Lariat epicardial ligation on mechanical function of the LA by performing ε and SR analysis before and after the procedure. METHODS: A total of 66 patients who underwent successful LAA exclusion were included in the study...
March 1, 2018: Heart Rhythm: the Official Journal of the Heart Rhythm Society
Bharath Yarlagadda, Valay Parikh, Tawseef Dar, Dhanunjaya Lakkireddy
Catheter based left atrial appendage (LAA) closure techniques are emerging as a promising alternative for stroke prevention in patients who cannot tolerate oral anticoagulation. Lariat procedure involves percutaneous catheter based epicardial ligation of the LAA with a suture via an endo-epicardial hybrid approach. It offers the advantage of not leaving behind a focus for thrombus formation or embolization. Similar to surgical ligation of the left atrial appendage, Lariat ligation is limited by leaks in a small percentage of patients...
October 2017: Journal of Atrial Fibrillation
Alan F Vainrib, Serge C Harb, Wael Jaber, Ricardo J Benenstein, Anthony Aizer, Larry A Chinitz, Muhamed Saric
Atrial fibrillation is the most common arrhythmia worldwide and is a major risk factor for embolic stroke. In this article, the authors describe the crucial role of two- and three-dimensional transesophageal echocardiography in the pre- and postprocedural assessment and intraprocedural guidance of percutaneous left atrial appendage (LAA) occlusion procedures. Although recent advances have been made in the field of systemic anticoagulation with the novel oral anticoagulants, these medications come with a significant risk for bleeding and are contraindicated in many patients...
April 2018: Journal of the American Society of Echocardiography
Jorge Romero, Andrea Natale, Luigi Di Biase
The role of pulmonary vein isolation in patients with non-paroxysmal atrial fibrillation (AF) is only modest. Several studies have demonstrated the role of the left atrial appendage (LAA) in initiating and maintaining of this arrhythmia. We review in this article the incremental benefit in free-arrhythmia recurrence of LAA electrical isolation in patients undergoing procedures for persistent AF or long standing persistent AF either using radiofrequency ablation, cryoablation or Lariat device implantation. Likewise, acute complications, anticoagulation and the risk of ischemic stroke after LAA electrical isolation (LAAEI) are analyzed...
November 2017: Portuguese Journal of Cardiology: An Official Journal of the Portuguese Society of Cardiology
Mohit Turagam, Donita Atkins, Matthew Earnest, Randall Lee, Jayant Nath, Ryan Ferrell, Krzysztof Bartus, Nitish Badhwar, Abdi Rasekh, Jie Cheng, Luigi Di Biase, Andrea Natale, David Wilber, Dhanunjaya Lakkireddy
BACKGROUND: The anatomical, electrical, and clinical impact of incomplete Lariat left atrial appendage ligation remains unclear. METHODS: We studied LAA anatomy pre- and postligation using contrast enhanced-computed tomography (CT) scans in 91 patients with atrial fibrillation (AF) who subsequently underwent catheter ablation (CA). RESULTS: Eleven patients had an incomplete exclusion (12%) with a central leak ranging from 1 to 5 mm. Despite incomplete ligation; the LAA volume were reduced by 67% postprocedurally when compared to preprocedure...
December 2017: Journal of Cardiovascular Electrophysiology
Rachele Contri, Sara Clivio, Tiziano Torre, Tiziano Cassina
Left atrial appendage (LAA) closure prevents thromboembolic risk and avoids lifelong anticoagulation due to atrial fibrillation (AF). Nowadays, AtriClip, a modern epicardial device approved in June 2010, allows external and safe closure of LAA in patients undergoing cardiac surgery during other open-chest cardiac surgical procedures. Such a surgical approach and its epicardial deployment differentiates LAA closure with AtriClip from percutaneous closure techniques such as Watchman (Boston Scientific, Marlborough, MA, USA), Lariat (SentreHEART Inc...
October 2017: Echocardiography
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...
December 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
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