TY - JOUR
T1 - Percutaneous epicardial left atrial appendage closure
T2 - Intermediate-term results
AU - Bruce, Charles J.
AU - Stanton, Christopher M.
AU - Asirvatham, Samuel J.
AU - Danielsen, Andrew J.
AU - Johnson, Susan B.
AU - Packer, Douglas L.
AU - Friedman, Paul A.
N1 - Copyright:
Copyright 2011 Elsevier B.V., All rights reserved.
PY - 2011/1
Y1 - 2011/1
N2 - Chronic Percutaneous Epicardial Appendage Closure. Objectives: To assess the chronic safety and feasibility of percutaneous epicardial closure of the left atrial appendage (LAA) guided by electrical navigation. Background: Atrial fibrillation (AF) is associated with stroke, and LAA occlusion may be a useful nonpharmacologic strategy for stroke prevention in AF. Methods: Percutaneous epicardial access was obtained in 6 dogs under general anesthesia. The ligation system included a grabber that captures the LAA guided by local electrograms (EGMs) and a looped hollow suture preloaded with a central wire enabling control and visualization. After a satisfactory position is confirmed the loop is tightened remotely, and the suture cut. Transesophageal echocardiography (TEE) assessed LAA dimensions and flow. LAA EGMs were recorded pre- and postclosure, and neurohormonal markers measured. Pathologic examination was performed. Results: LAA ligation was successful in all dogs. LAA flow was immediately abolished in 5 of 6 dogs. Disappearance of local LAA EGMs following ligation was observed in all animals. Follow-up TEE at mean 54 days (range 23-75 days) documented residual flow in only the first 2 dogs. Prior to necropsy the LAA was examined at thoracotomy in 3 animals. Following a minor design change, complete closure and fibrosis with a remnant atretic LAA was noted in all animals. No damage to adjacent structures was noted. Neurohormonal markers were unchanged. Conclusion: Percutaneous epicardial LAA ligation guided by electrical navigation is feasible with promising intermediate-term results in the canine model. The technique may be useful as an alternative to existing methods of LAA obliteration in humans.
AB - Chronic Percutaneous Epicardial Appendage Closure. Objectives: To assess the chronic safety and feasibility of percutaneous epicardial closure of the left atrial appendage (LAA) guided by electrical navigation. Background: Atrial fibrillation (AF) is associated with stroke, and LAA occlusion may be a useful nonpharmacologic strategy for stroke prevention in AF. Methods: Percutaneous epicardial access was obtained in 6 dogs under general anesthesia. The ligation system included a grabber that captures the LAA guided by local electrograms (EGMs) and a looped hollow suture preloaded with a central wire enabling control and visualization. After a satisfactory position is confirmed the loop is tightened remotely, and the suture cut. Transesophageal echocardiography (TEE) assessed LAA dimensions and flow. LAA EGMs were recorded pre- and postclosure, and neurohormonal markers measured. Pathologic examination was performed. Results: LAA ligation was successful in all dogs. LAA flow was immediately abolished in 5 of 6 dogs. Disappearance of local LAA EGMs following ligation was observed in all animals. Follow-up TEE at mean 54 days (range 23-75 days) documented residual flow in only the first 2 dogs. Prior to necropsy the LAA was examined at thoracotomy in 3 animals. Following a minor design change, complete closure and fibrosis with a remnant atretic LAA was noted in all animals. No damage to adjacent structures was noted. Neurohormonal markers were unchanged. Conclusion: Percutaneous epicardial LAA ligation guided by electrical navigation is feasible with promising intermediate-term results in the canine model. The technique may be useful as an alternative to existing methods of LAA obliteration in humans.
KW - anticoagulation
KW - atrial fibrillation
KW - left atrial appendage
KW - stroke
KW - transesophageal echocardiography
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U2 - 10.1111/j.1540-8167.2010.01855.x
DO - 10.1111/j.1540-8167.2010.01855.x
M3 - Article
C2 - 20662983
AN - SCOPUS:78751535807
SN - 1045-3873
VL - 22
SP - 64
EP - 70
JO - Journal of cardiovascular electrophysiology
JF - Journal of cardiovascular electrophysiology
IS - 1
ER -