LARIAT Trial Updates

Overview

Journal J Atr Fibrillation

Date 2018 Nov 21

PMID 30455830

Citations 4

Authors

Dan Musat

Suneet Mittal

Affiliations

Soon will be listed here.

Abstract

The thrombus formed within the LAA is responsible for the vast (about 90%) majority of strokes. Anticoagulation, although effective therapy for stroke prevention is not feasible in a significant minority of patients due to various reasons. Two percutaenous LAA exclusion techniques have been developed in an effort to decrease risk for stroke: endocardial closure/plugging of the LAA (Watchman, Amplatzer devices) and epicardial LAA ligation (LARIAT). The aim of this study is to review the trial data to date for the LARIAT device. The LARIAT suture has been used in more than 4500 patients with high success of LAA complete closure (92-100%), mostly in the patients unable to take anticoagulation and in a small minority as antiarrhythmic option. The LARIAT technique has evolved with a change in pericardial access method that resulted in dramatic improvement of safety. LAA closure performance with LARIAT system seems to be similar to Watchman device, with small leaks during follow-up in 6-24% of the cases, which do not to correlate with thrombo-embolic events. LAA has been proven to play an important triggering role in patients with persistent atrial fibrillation. Small studies had shown that LAA ligation with LARIAT could terminate persistent atrial fibrillation and possible improve ablation success. Ongoing aMAZE randomized trial is studying if LAA ligaiton using LARIAT suture leads to improved atrial fibrillation ablation success. Available data suggests that LAA closure using LARIAT epicardial suture is a good alternative for stroke risk reduction in patients who are unable to be on anticoagulation therapy. LARIAT system might improve success of AF ablation for patients with persistent and long persistent AF, pending the results of the ongoing aMAZE trial.

Citing Articles

Novel Anticoagulants for Stroke Prevention in Atrial Fibrillation: A Comprehensive Review.

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PMID: 39184779 PMC: 11344489. DOI: 10.7759/cureus.65347.

The Left Atrial Appendage and Atrial Fibrillation-A Contemporary Review.

Sulague R, Whitham T, Danganan L, Effiom V, Candelario K, Latif N J Clin Med. 2023; 12(21).

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Case Report: Giant Congenital Left Atrial Appendage Aneurysm Presenting With Acute Massive Cerebral Infarction and Refractory Atrial Fibrillation: A Case Report and Literature Review.

Li R, Ma F, Guan H, Pan Y, Liu L, Wang D Front Cardiovasc Med. 2022; 9:888825.

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Long-Term Stroke Risk in Patients Undergoing Left Atrial Appendage Ablation With and Without Complete Isolation.

Dhorepatil A, Lang A, Lang M, Butt M, Arbune A, Hoffman D Front Cardiovasc Med. 2021; 8:762839.

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