Endocardial (Watchman) vs epicardial (Lariat) left atrial appendage exclusion devices: Understanding the differences in the location and type of leaks and their clinical implications

Left atrial appendage occlusion for stroke prevention in diabetes mellitus patients with atrial fibrillation: Long‐term results

“…After 6 weeks of implantation, complete epithelialization of the device surface is observed . Other techniques include epicardial approaches using a Lariat device (SentreHEART, Redwood, CA, USA) for epicardial ligation of the LAA with sutures, with leaves no foreign body implanted in the LAA . After epicardial exclusion, a significant inflammatory response is observed and the LAA is permanently closed .…”

Safety profiles of percutaneous left atrial appendage closure devices: An analysis of the Food and Drug Administration Manufacturer and User Facility Device Experience (MAUDE) database from 2009 to 2016

“…During this span, refinements for the LARIAT included improved patient selection with increased operator experience, the adoption of a micropuncture needle and telescoping technique for “dry” pericardial access, and periprocedural colchicine for pericarditis prophylaxis . Despite the overall favorable trend, LARIAT‐related MAUDE data suffer from underreporting, as evidenced by the absence of reports for postprocedural LAA leaks and intracardiac thrombi, which are well‐documented in the literature …”

Left Atrial Appendage Occlusion: What Are the Options and Where is the Evidence?

“…47,48 Furthermore, based on data from a third multicenter prospective observational study of note, in comparison with the WATCHMAN™ device (Boston Scientific, Natick, MA, USA), use of the LARIAT ® device (SentreHEART, Redwood City, CA, USA) is associated with a lower rate of residual leaks at one year postoperation, though, notably, there was no difference in the incidence rate of cerebrovascular accidents in the two device groups, despite the differences in residual leaks. 49 LAA leaks from incomplete ligation following the LARIAT ® procedure (Sentre-HEART, Redwood City, CA, USA) are not uncommon and can be closed using the AMPLATZER™ septal occluder (Abbott Laboratories, Chicago, IL, USA) or via a repeat LARIAT ® procedure (SentreHEART, Redwood City, CA, USA). 50,51 In the setting of a foreign body being present in the left atrium from endocardial occlusive device use, platelet aggregation leads to thrombus formation.…”