Percutaneous Epicardial Left Atrial Appendage Closure: Preliminary Results of an Electrogram Guided Approach

Percutaneous Epicardial Left Atrial Appendage Closure: Preliminary Results of an Electrogram Guided Approach

Author Friedman, Paul A. Google Scholar
Asirvatham, Samuel J. Google Scholar
Dalegrave, Charles Autor UNIFESP Google Scholar
Kinoshita, Masayoshi Google Scholar
Danielsen, Andrew J. Google Scholar
Johnson, Susan B. Google Scholar
Hodge, David O. Google Scholar
Munger, Thomas M. Google Scholar
Packer, Douglas L. Google Scholar
Bruce, Charles J. Google Scholar
Institution Mayo Clin
Universidade Federal de São Paulo (UNIFESP)
Mayo Clin Hlth Solut
Abstract Background: Pharmacologic therapies to prevent stroke in atrial fibrillation (AF) have numerous limitations, prompting the development of device-based therapies. We investigated whether an electrogram-based approach using a novel hollow suture can safely capture and ligate the left atrial appendage (LAA).Methods and Results: A novel system for closure of the LAA within the confines of the closed pericardium with a single sheath puncture was tested in 4 dogs. the tool used to grasp the appendage was fitted with electrodes and utilized electrical navigation to identify and confirm LAA capture. A hollow suture preloaded with a mechanical support wire to permit its manipulation and fluoroscopic visualization was advanced over the grasper, and the wire removed after the suture was positioned. the LAA was successfully closed in all dogs. in 2 dogs, after closure, a thoracotomy was performed and the LAA amputated without bleeding, confirming closure integrity. Necropsy confirmed closure in all animals.Conclusions: Using electrical navigation, percutaneous epicardial LAA ligation with a remotely tightened suture was performed successfully within the confines of the intact pericardial space. This technique may allow decreasing the risk of stroke in AF patients without the need for thoracotomy or an endocardially placed prosthetic device.(J Cardiovasc Electrophysiol, Vol. 20, pp. 908-915, August 2009).
Keywords left atrial appendage
atrial fibrillation
stroke
epicardial
electrograms
Language English
Sponsor Aegis Medical (Vancouver, Canada)
Mayo Discovery Translation Award
Date 2009-08-01
Published in Journal of Cardiovascular Electrophysiology. Malden: Wiley-Blackwell Publishing, Inc, v. 20, n. 8, p. 908-915, 2009.
ISSN 1045-3873 (Sherpa/Romeo, impact factor)
Publisher Wiley-Blackwell
Extent 908-915
Origin http://dx.doi.org/10.1111/j.1540-8167.2009.01465.x
Access rights Closed access
Type Article
Web of Science ID WOS:000268457600013
URI http://repositorio.unifesp.br/handle/11600/31737

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