Percutaneous epicardial left atrial appendage closure: Intermediate-term results

Charles J. Bruce, Christopher M. Stanton, Samuel J. Asirvatham, Andrew J. Danielsen, Susan B. Johnson, Douglas L. Packer, Paul A. Friedman

Research output: Contribution to journalArticlepeer-review

33 Scopus citations

Abstract

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.

Original languageEnglish (US)
Pages (from-to)64-70
Number of pages7
JournalJournal of cardiovascular electrophysiology
Volume22
Issue number1
DOIs
StatePublished - Jan 2011

Keywords

  • anticoagulation
  • atrial fibrillation
  • left atrial appendage
  • stroke
  • transesophageal echocardiography

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

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