LAA ligation using the LARIAT suture delivery device Tips and tricks for a successful procedure》.pdfVIP

HANDS ON LAA ligation using the LARIAT suture delivery device: Tips and tricks for a successful procedure Jayanthi N. Koneru, MBBS,* Nitish Badhwar, MBBS, FHRS, CCDS,† Kenneth A. Ellenbogen, MD, FHRS,* Randall J. Lee, MD†‡ * From the Cardiac Electrophysiology, Division of Cardiology, Virginia Commonwealth University Medical Center, Richmond, Virginia, †Department of Medicine and ‡Cardiovascular Research Institute, University of California, San Francisco, San Francisco, California. Introduction A flow diagram of the steps involved in the procedure is Chronic oral anticoagulation (OAC) has traditionally been depicted in Figure 1, and an overview of these steps is considered as the most effective prophylaxis against throm- depicted in Figure 2 and Online Supplemental Movie 1. boembolic events in patients with atrial fibrillation (AF). However, as many as 20% of the patients with AF are not Preprocedural planning candidates for OAC.1,2 Reasons for ineligibility range from Patient selection intracranial bleeding (the most serious complication) to increased propensity for mechanical injury (the least serious On the basis of the published data, we consider performing complication). The resumption of OAC in patients who have this procedure in patients with AF who have risk factors for suffered a life-threatening complication due to OAC is stroke and contraindications to OAC (Table 1). The percuta- associated with a much higher risk of such events in the neous LAA ligation procedure requires the LARIAT device future. to be freely mobile within the