Percutaneous Epicardial Left Atrial Appendage Closure: Intermediate-Term Results

Abstract

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.

Stroke Prevention in Atrial Fibrillation: Atrial Appendage Closure

“…The Aegis System (Vancouver, Canada), a percutaneous device, consists of a "grabber" with integrated electrodes to identify the LAA under fluoroscopic guidance, and a ligator (hollow suture) to cinch the LAA at the base. Ligation of the LAA was successful in 5 out of 6 dogs in a preclinical study [34]. Necropsy after 2 to 3 months revealed an atretic remnant LAA in the animals.…”

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

“…64 In earlier studies, a percutaneous electrogram-based approach to capture and ligate the LAA via the use of a hollow suture preloaded with a mechanical support wire used to approximate under fluoroscopic guidance was successfully completed in dogs and achieved complete closure and fibrosis, with a remnant atretic LAA noted in all animals. 65,66 Additionally, a multicenter study on the efficacy and safety of LAA closure using an epicardial suture snaring device was expected to begin last year.…”

Left Atrial Appendage Exclusion for Atrial Fibrillation

“…The Aegis system (Aegis Medical, Vancouver, Canada, Epitek, Minneapolis, MN, USA) 21, 162 introduces an appendage grabber, via percutaneous sub-xiphoid pericardial access, with embedded electrodes within the jaws permitting electrical navigation onto the appendage via bipolar electrograms that identify the electrical activity of the tissue captured by the jaws. A hollow suture preloaded with a support wire to permit remote suture loop manipulation and fluoroscopic visualization is advanced to the appendage base and looped around the appendage.…”

“…21 Chronically, the LAA involutes and becomes atretic. 162 Whether LAA elimination by this means will impact rhythm control (by eliminating a mass of fibrillating atrial tissue) is not known. A small series has demonstrated feasibility in humans.…”