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Percutaneous epicardial left atrial appendage closure: intermediate-term results.
MedLine Citation:
PMID:  20662983     Owner:  NLM     Status:  In-Data-Review    
Abstract/OtherAbstract:
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. (J Cardiovasc Electrophysiol, Vol. 22, pp. 64-70, January 2011).
Authors:
Charles J Bruce; Christopher M Stanton; Samuel J Asirvatham; Andrew J Danielsen; Susan B Johnson; Douglas L Packer; Paul A Friedman
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Journal of cardiovascular electrophysiology     Volume:  22     ISSN:  1540-8167     ISO Abbreviation:  J. Cardiovasc. Electrophysiol.     Publication Date:  2011 Jan 
Date Detail:
Created Date:  2011-01-17     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9010756     Medline TA:  J Cardiovasc Electrophysiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  64-70     Citation Subset:  IM    
Copyright Information:
© 2010 Wiley Periodicals, Inc.
Affiliation:
Division of Cardiovascular Disease, Department of Internal Medicine Mayo Clinic, Rochester, Minnesota, USA.
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