Percutaneous Endocardial Occlusion of Incompletely Surgically Ligated Left Atrial Appendage
Drs. Aryana and d'Avila have received consulting fees and speaker honoraria from St. Jude Medical, Inc., the manufacturer of the Amplatzer Septal Occluder device. Dr. O'Neill has received honoraria from St. Jude Medical, Inc. Other authors: No disclosures.
Address for correspondence: Arash Aryana, M.D., F.A.C.C., F.H.R.S., Regional Cardiology Associates and Mercy Heart & Vascular Institute, 3941 J Street, Suite #350, Sacramento, CA 95819, USA. Fax: +916-456-1672; E-mail: email@example.com
Percutaneous Endocardial Occlusion of ISLL
Surgical ligation of the left atrial appendage is considered standard of care in patients who undergo mitral valve surgery or as an adjunct to a surgical Maze procedure for treatment of atrial fibrillation (AF). However, several studies have demonstrated that this can result in incompletely surgically ligated left atrial appendage (ISLL) in a significant number of patients. It is believed that ISLL may in turn promote thrombus formation and lead to clinically relevant thromboembolic events. A novel approach for percutaneous endocardial occlusion of ISLL is described.
Methods and Results
Seven patients with AF and ISLL following prior open-chest, surgical suture ligation in the absence of rheumatic heart disease, underwent percutaneous endocardial ISLL occlusion using an Amplatzer Septal Occluder device guided by fluoroscopy and transesophageal echocardiography through a novel approach. Three patients were diagnosed in the setting of acute embolic stroke, 2 at the time of cardiac arrhythmia ablation and 2 by elective precardioversion transesophageal echocardiography. All patients were treated with oral anticoagulation therapy. Acute and long-term ISLL occlusion was successfully achieved in 6 patients, in whom oral anticoagulation was eventually discontinued without any embolic events during 10 ± 2 months of follow-up.
Percutaneous endocardial occlusion of ISLL is feasible using an Amplatzer Septal Occluder device. Additional studies are required to evaluate the long-term safety and efficacy of this therapeutic treatment strategy in patients with ISLL.