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Randall J. Lee - One of the best experts on this subject based on the ideXlab platform.
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Clinical Significance of Leaks Following Left Atrial Appendage Ligation With the LARIAT Suture Delivery Device.
Jacc-cardiovascular Interventions, 2016Co-Authors: Randall J. LeeAbstract:The LARIAT Device (SentreHeart, Redwood City, California) utilizes a combined endocardial and epicardial approach to place an epicardial Suture to ligate the left atrial appendage (LAA) [(1)][1]. The initial prospective efficacy and safety study on the LARIAT Device demonstrated an acute closure
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Left atrial appendage ligation with the next generation LARIAT+ Suture Delivery Device: Early clinical experience
International Journal of Cardiology, 2016Co-Authors: Krzysztof Bartus, Sameer Gafoor, David Tschopp, John P. Foran, Roland Richard Tilz, Tom Wong, Dhanunjaya Lakkireddy, Horst Sievert, Randall J. LeeAbstract:Abstract Background The purpose of the study was to determine the efficacy and safety of left atrial appendage (LAA) closure with a micropuncture pericardial access approach and the new LARIAT + Suture Delivery Device. Methods Seventy-two patients with atrial fibrillation were enrolled to undergo telescopic micropuncture pericardial access and percutaneous ligation of the LAA with the LARIAT + Device. LAA closure was confirmed with transesophageal echocardiography (TEE) and contrast fluoroscopy immediately, then with TEE at 30days and 90days post-LAA ligation. Patients were monitored for 12months by an independent clinical research organization for adverse events, stroke, embolic events and death of any cause. Results 72 patients were screened for the LARIAT + procedure. Fourteen patients were screened failures (7 patients due to unfavorable anatomy and 7 patients with LAA thrombus). Fifty-eight patients underwent successful LAA ligation. All 58 patients had complete acute closure of the LAA. At 1month 52 of 54 patients (96.3%) had LAA closure, while at 3months 48 of 52 patients (92.3%) had LAA closure. There were no leaks greater than 3mm at both 1 and 3months. There were no Device or procedural related complications, and only 1 30day adverse event involving late pericardial effusion. There were no strokes, embolic events or deaths after 12months. Conclusions LAA closure with the micropuncture pericardial access approach and the LARIAT + Device can be performed effectively with acceptably low periprocedural adverse events.
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Anatomic analysis of the left atrial appendage after closure with the LARIAT Device.
Circulation-arrhythmia and Electrophysiology, 2014Co-Authors: Krzysztof Bartus, Remo L. Morelli, Wojciech Szczepanski, Bogusław Kapelak, Jerzy Sadowski, Randall J. LeeAbstract:The pathophysiologic role of the left atrial appendage (LAA) in thromboembolic disease and as the primary source for cardioembolic events in patients with atrial fibrillation (AF) has been recognized since the 1950s.1 This has led to the development of percutaneous approaches to exclude LAA, including LAA ligation with the LARIAT Suture Delivery Device (SentreHEART, Inc, Redwood City, CA).2 However, the anatomic consequences of percutaneous LAA ligation are unknown. This report describes LAA gross anatomy and histological consequences of LAA ligation from 2 patients. A 63-year-old man with a history of persistent AF on chronic warfarin oral anticoagulation was referred for LAA exclusion after severe gastrointestinal bleeding and history of falling resulting in a hip fracture. His past medical history included hypertension, diabetes mellitus, previous myocardial infarctions, congestive heart failure, end-stage renal disease on hemodialysis, peripheral vascular disease, status post–femoral popliteal bypass surgery, and hip fracture. The patient had a CHADS2 score of 3, CHADS-Vasc score of 4, and a HAS-Bleed score of 4. The patient underwent an uncomplicated closed-chested LAA ligation with the LARIAT Suture Delivery Device.2 LAA closure was confirmed with transesophageal echocardiography (TEE) and contrast fluoroscopy acutely (Figure 1). The patient did well post-LAA closure and was on no antiplatelet or antithrombin medications. A follow-up TEE performed at 8 months revealed a closed LAA with no leaks. Eleven months after his LAA ligation, the patient was admitted to the hospital with pneumonia and volume-overloaded congestive heart failure. During dialysis, the patient had a ventricular fibrillation arrest. Cardiac resuscitation was initiated but was unsuccessful and the patient …
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LAA ligation using the LARIAT Suture Delivery Device: Tips and tricks for a successful procedure☆
Heart Rhythm, 2014Co-Authors: Jayanthi N. Koneru, Nitish Badhwar, Kenneth A. Ellenbogen, Randall J. LeeAbstract:intracranial bleeding (the most serious complication) to increased propensity for mechanical injury (the least serious complication). The resumption of OAC in patients who have suffered a life-threatening complication due to OAC is associated with a much higher risk of such events in the future. Alternative treatment options for this subset of patients include surgical and percutaneous catheter–based exclusion of the left atrial appendage (LAA). Of these, the percutaneous catheter–based LAA ligation procedure with the LARIAT Suture Delivery Device (SentreHEART, Inc, Redwood City, CA) is an option that uses a combined endocardial and epicardial approach for LAA closure. It is technically feasible and has been shown to produce complete and long-term closure of the LAA. 3–5 We provide a step-bystep approach to LAA ligation with the LARIAT Suture Delivery Device. This article provides useful hands-on information on a successful procedure with the LARIAT Device but is not a substitute for proctoring—a necessity for the initial cases. A flow diagram of the steps involved in the procedure is depicted in Figure 1, and an overview of these steps is depicted in Figure 2 and Online Supplemental Movie 1. Preprocedural planning Patient selection On the basis of the published data, we consider performing this procedure in patients with AF who have risk factors for stroke and contraindications to OAC (Table 1). The percutaneous LAA ligation procedure requires the LARIAT Device to be freely mobile within the pericardial space; therefore, prior open heart surgery is an absolute contraindication. A clinical history of severe pericarditis, epicardial VT ablation, uremia, pectus excavatum, and severe obesity are relative contraindications.
Yitschak Biton - One of the best experts on this subject based on the ideXlab platform.
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Percutaneous left atrial appendage occlusion in the prevention of stroke in atrial fibrillation: a systematic review
Heart Failure Reviews, 2018Co-Authors: Jayson R. Baman, Moussa Mansour, E. Kevin Heist, David T. Huang, Yitschak BitonAbstract:Atrial fibrillation is commonly coexistent with heart failure, and the management of the heart failure patient would be incomplete without an appreciation for atrial fibrillation management. There are many complications associated with oral anticoagulation in the prevention of stroke related to atrial fibrillation. In recent years, the advent of several percutaneous left atrial appendage (LAA) occlusion/closure strategies has sought to provide an alternative treatment modality. Here, we systematically review the published literature to investigate the efficacy and safety of percutaneous LAA occlusion/closure Devices. We searched PubMed, EMBASE, Cochrane database of systematic reviews, and the FDA Medical Devices database. Using prespecified criteria, we identified studies of the Amplatzer Cardiac Plug (St. Jude Medical), Amplatzer Amulet (St. Jude Medical), Lariat Suture Delivery Device (SentreHeart), and Watchman Device (Boston Scientific). We analyzed 2 randomized controlled trials (RCT) and 15 non-randomized registries that satisfied the study criteria. The two RCT both studied the Watchman Device versus standard warfarin therapy; the studies indicate that the Watchman may be non-inferior to warfarin. Long-term efficacy outcomes for the Watchman Device are promising. Data regarding the Amplatzer Cardiac Plug, Amplatzer Amulet, and Lariat Suture Delivery Device are limited by the paucity of RCT data. High-quality prospective research is needed to directly compare LAA occlusion/closure strategies against one another as well as versus the direct oral anticoagulation medications. Data regarding the role of LAA occlusion in the heart failure population are lacking.
Dhanunjaya Lakkireddy - One of the best experts on this subject based on the ideXlab platform.
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Left atrial appendage ligation with the next generation LARIAT+ Suture Delivery Device: Early clinical experience
International Journal of Cardiology, 2016Co-Authors: Krzysztof Bartus, Sameer Gafoor, David Tschopp, John P. Foran, Roland Richard Tilz, Tom Wong, Dhanunjaya Lakkireddy, Horst Sievert, Randall J. LeeAbstract:Abstract Background The purpose of the study was to determine the efficacy and safety of left atrial appendage (LAA) closure with a micropuncture pericardial access approach and the new LARIAT + Suture Delivery Device. Methods Seventy-two patients with atrial fibrillation were enrolled to undergo telescopic micropuncture pericardial access and percutaneous ligation of the LAA with the LARIAT + Device. LAA closure was confirmed with transesophageal echocardiography (TEE) and contrast fluoroscopy immediately, then with TEE at 30days and 90days post-LAA ligation. Patients were monitored for 12months by an independent clinical research organization for adverse events, stroke, embolic events and death of any cause. Results 72 patients were screened for the LARIAT + procedure. Fourteen patients were screened failures (7 patients due to unfavorable anatomy and 7 patients with LAA thrombus). Fifty-eight patients underwent successful LAA ligation. All 58 patients had complete acute closure of the LAA. At 1month 52 of 54 patients (96.3%) had LAA closure, while at 3months 48 of 52 patients (92.3%) had LAA closure. There were no leaks greater than 3mm at both 1 and 3months. There were no Device or procedural related complications, and only 1 30day adverse event involving late pericardial effusion. There were no strokes, embolic events or deaths after 12months. Conclusions LAA closure with the micropuncture pericardial access approach and the LARIAT + Device can be performed effectively with acceptably low periprocedural adverse events.
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Left atrial thrombus formation after successful left atrial appendage ligation: case series from a nationwide survey.
Journal of the American College of Cardiology, 2015Co-Authors: Dhanunjaya Lakkireddy, David Rubenson, Miguel Valderrábano, Ajay Vallakati, Arun Kanmanthareddy, Ted Feldman, Douglas Gibson, Matthew Price, Jie Cheng, Rajeev R. FernandoAbstract:Percutaneous left atrial appendage (LAA) exclusion can be performed using endocardial occlusion Devices or an endoepicardially placed Suture Delivery Device (1-3). Thrombus formation on endocardial occlusion Devices (Watchman, Boston Scientific, Marlborough, Massachusetts; or Amplatzer Cardiac Plug [ACP], St. Jude Medical, St. Paul, Minnesota) (1,2) has been attributed to platelet aggregation in the setting of a foreign body in the left atrium (LA). With the percutaneous endoepicardial ligation technique (Lariat, SentreHEART, Redwood City, California), there is no foreign body left behind, and the risk of thrombus formation should be insignificant. This study describes the clinical course of LA thrombi after the Lariat procedure in 19 patients. We conducted a nationwide survey of physicians performing procedures with the Lariat Device in the United States to identify patients who developed LA thrombus after the procedure. Our study cohort comprised patients found to have LA thrombus post-procedure. Post-procedure surveillance imaging was not uniform across centers. Most patients underwent transesophageal echocardiogram (TEE)/computed tomography at 1 to 3 months post-procedure. Anticoagulation/antiplatelet therapy was initiated immediately after detection of LA thrombus. We collected demographic, clinical, and pre-procedural imaging characteristics of patients. Procedural variables and clinical course of patients after thrombus detection were recorded. Statistical analyses were performed using SPSS version 19.0 for Windows (SPSS, Inc., Chicago, Illinois). A total of 47 operators participated in the survey. Routine post-procedure imaging was performed by 44 (93.6%) operators. Three (6.4%) operators performed imaging only if clinically indicated. Routine post-procedure follow-up imaging was performed at 1 to 3 months and 3 to 6 months by 80% and 40% of the operators, respectively. Of the 964 patients who underwent the procedure, 19 (2%) had an LA thrombus. Table 1 lists some patient characteristics and includes follow-up data of the 19 patients. TABLE 1 Patient Characteristics and Follow-Up (n = 19) LA thrombus was detected within 90 days in 15 (79%) patients. TEEs performed in the first 6 months were negative for thrombi in 2 patients with clots discovered >200 days after the procedure. Eighteen patients received oral anticoagulants after detection of LA thrombus, whereas 1 patient received antiplatelet therapy. Thrombus remained unchanged at 90 days in the latter patient, requiring a switch to rivaroxaban. Serial TEEs were performed until thrombus resolution. Oral anticoagulation was discontinued in 16 patients after clot resolution, whereas 3 patients with unresolved thrombi remained on anticoagulation (30, 58, and 80 days, respectively). None of the patients had clinical evidence of stroke or peripheral embolism during follow-up. Our study highlights that the risk of LA thrombus formation with the Device is low (2%). Most (79%) cases were detected within the first 90 days. Prompt initiation of anticoagulation can lead to thrombus resolution. This is the first investigation to describe the clinical course of LA thrombus post-procedure in a large cohort of patients receiving the Lariat Device. In a clinical study involving 89 patients, no case of LA thrombus was detected on the 30-day post-procedure TEE. However, 1 patient had an LA thrombus away from the site of occlusion at 1-year follow-up (3). Our study is consistent in that, although uncommon, an LA thrombus can develop after the procedure. The pathophysiology of LA thrombus formation after the Lariat procedure remains unclear. Focal endocardial damage and inflammation around the LAA orifice secondary to tissue compression from the Lariat Suture, causing edema and ischemic necrosis around the ligation site, can increase the propensity for LA thrombus formation. In our study, 17 of 19 (89%) patients developed a thrombus at the ligation site. Currently, there are no clear guidelines on LA thrombus surveillance after LAA ligation. We strongly support a follow-up TEE 30 to 90 days post-procedure. Given that the risk of thrombus formation is greatest during the first 3 months post-procedure, it may be appropriate for patients to receive antiplatelet or anticoagulant therapy during this period. The risk of LA thrombus in the absence of anticoagulation use post-procedure is low and is more frequently seen during the first 3 months after LAA ligation. Periodic imaging studies are essential for early detection of an LA thrombus. With prompt initiation of anticoagulation and close supervision, an LA thrombus can be managed safely.
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Differences in Experience With a New Delivery Device for LAA Ligation Among Various U.S. Centers
Journal of the American College of Cardiology, 2015Co-Authors: Abdi Rasekh, Nitish Badhwar, Saibal Kar, Hosakote Nagaraj, Ali Massumi, Dhanunjaya LakkireddyAbstract:The Lariat Suture Delivery Device (SentreHeart, Redwood City, California) has been used to exclude the left atrial appendage (LAA). Thus far, there have not been any randomized controlled trials or large multicenter experiences reported on the Device. Price et al. made an attempt to describe their
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The effects of LAA ligation on LAA electrical activity
Heart Rhythm, 2014Co-Authors: Frederick T. Han, Nitish Badhwar, Krzysztof Bartus, Dhanunjaya Lakkireddy, Bogusław Kapelak, Jerzy Sadowski, Francia Rojas, Jacek Bednarek, Magdalena Bartus, Mathew EarnestAbstract:Background The arrhythmic role of the left atrial appendage (LAA) has been implicated in the maintenance of persistent atrial fibrillation. LAA isolation with catheter ablation has been successful but is limited by the risk of tamponade and electromechanical dissociation with the potential for LAA thrombus formation. Objective To assess whether LAA ligation results in LAA electrical isolation. Methods A total of 68 patients with contraindication or intolerance to oral anticoagulation therapy underwent LAA ligation with the LARIAT Suture Delivery Device. Patients had unipolar [n = 30(44%)] or bipolar [n = 38(56%)] voltage measurements pre- and post-LAA ligation. Results All 68 patients underwent successful LAA ligation. There was a statistically significant reduction in the mean LAA voltage from pre-ligation (unipolar pre-ligation voltage 1.1 ± 0.53 mV; bipolar pre-ligation voltage 4.7 ± 2.83 mV) to post-ligation (unipolar post-ligation voltage 0.3 ± 0.38 mV; bipolar post-ligation voltage 0.6 ± 0.27 mV). Ninety-four percent of the patients had a reduction in the LAA voltage after the closure of the snare, with 10 of 30 (33%) of the patients having complete elimination of LAA voltage with the initial tightening of the Suture. Pacing from the LAA after the closure of the snare resulted in lack of capture of the left atrium in 28 of 31 patients. Conclusions The snare closure of the LAA using the LARIAT Device produces an acute reduction in the LAA voltage and inhibits the capture of the left atrium during LAA pacing. Future studies are needed to determine whether LAA ligation affects atrial fibrillation burden.
Abdi Rasekh - One of the best experts on this subject based on the ideXlab platform.
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Where We Stand on Left Atrial Appendage Closure for Stroke Prevention in Atrial Fibrillation.
Texas Heart Institute Journal, 2016Co-Authors: Payam Safavi-naeini, Abdi RasekhAbstract:A trial fibrillation (AF) is the most prevalent cardiac arrhythmia—found in 1% to 2% of the general population.1 It is also a major cause of ischemic stroke. Patients with AF are 4 to 5 times more likely to have an ischemic stroke.2 Their annual rate of stroke is 5%, which accounts for 15% of all strokes in the United States.2,3 The left atrial appendage (LAA) is a trabeculated cul-de-sac that is responsible for more than 90% of thrombus formations in AF patients.4 Because of these findings, LAA closure Devices have been developed as an alternative to oral anticoagulant (OAC) therapy. The first generation of endocardial LAA occluders comprised 3 Devices: the Percutaneous LAA Transcatheter Occlusion system (Plaato) (ev3 Inc.; Plymouth, Minn), the Watchman™ Left Atrial Appendage Closure Device (Boston Scientific Corporation; Natick, Mass), and the Amplatzer™ Cardiac Plug (ACP) Device (St. Jude Medical, Inc.; Minneapolis, Minn). Plaato withdrew from the market in 2006, and the ACP is not yet available for commercial use in the U.S.5 The newer generation of endocardial LAA occluders comprises the WaveCrest® LAA Occlusion System (Coherex Medical, Inc.; Salt Lake City, Utah), the LAmbre™ Left Atrial Appendage Occluder (Lifetech Scientific [Shenzhen] Co., Ltd.; Shenzhen, PRC), and the Ultrasept LAA Closure Device (Cardia Inc.; Eagan, Minn), none of which is available for commercial use in the U.S.6 If you prefer to perform LAA closure through an epicardial approach, the Lariat® Suture Delivery Device (Sentre-Heart, Inc.; Redwood City, Calif) and the Aegis Device (Aegis Medical Innovations Inc.; Vancouver, Canada) will permit that. But the Aegis Device is available for investigational use only.6 The Watchman Clinical Trial Experience The Watchman LAA Closure Technology for Embolic Protection in Patients with Atrial Fibrillation (Protect AF) clinical trial was designed to examine the safety and efficacy of the Watchman Device in patients with nonvalvular AF who were eligible for warfarin therapy and had a CHADS2 stroke-risk score of 1 or greater.7 From February 2005 through June 2008, 707 patients at 59 centers in the U.S. and Europe were enrolled in the Protect AF study. The patients were randomly assigned in a 2:1 ratio to percutaneous closure of the LAA and subsequent discontinuation of warfarin (n=463), or to warfarin treatment. All patients were monitored for 12 months.7 The Protect AF trial showed that the Watchman LAA Closure is noninferior to warfarin for the combined endpoint of stroke, systemic embolism, and death, and it is a safe and effective alternative to OAC therapy in decreasing the risk of AF-related stroke.7,8 The Protect AF trial showed a high rate (8.7%) of implant Device-related sequelae, including perforations and pericardial effusions, and had a procedural failure rate of around 9%. However, most of these events occurred during the early stages of the trial, and procedural failure rates declined as surgeons became more experienced with the operation.9 According to the Protect AF trial, the U.S. Food and Drug Administration (FDA) review panel required a 2nd trial to show that the lower procedural failure rate at the late stages of the study could be maintained across various hospitals and with new operators. In order to respond to the FDA panel's concerns, a 2nd trial, The Prospective Randomized EVAluation (Prevail), was designed, involving 407 patients randomly distributed in a 2:1 ratio to warfarin (as a control group) or to Watchman LAA Closure. These 407 patients were warfarin-eligible and had a mean CHADS2 score of 2.6 ± 1.10 The Prevail study showed an overall 95% success rate for implanting the Device (93.2% for new surgeons), and the overall 7-day serious procedure- or Device-related complication rate was 4.4% (a 49% relative reduction rate) in comparison with Protect AF, which had an 8.7% Device-related complication rate.10 The Protect AF/Prevail meta-analysis (2,406 patients and 5,931 years of patient follow-up) showed that rates of hemorrhagic stroke, nonprocedural bleeding, and cardiovascular and unexplained deaths were decreased among patients who had LAA closure with use of the Watchman, versus patients who were on long-term OAC therapy.11 It bears mention, however, that if periprocedural complications were included, there would be no significant differences in rates of all-cause death or major bleeding.12 Lariat Studies The Lariat is a minimally invasive procedure to tie off the LAA and remove the main source of AF-related stroke for patients who are at high risk of stroke and are not suitable candidates for OAC therapy. A single-center, nonrandomized study (Place II) showed about a 96% incidence of effective LAA closure (85 of 89 procedures). Three adverse events (3.3%) were reported, including bleeding (2 pericardial and 1 transseptal). The study investigators determined that the Lariat procedure can effectively close the LAA, with acceptable low-access sequelae and periprocedural adverse events.13 To date, the Lariat has not been involved in any prospective randomized trials, but published clinical results for single-center studies (together with a recent multicenter study) provide insight into the potential of the Lariat as a method of LAA closure, as well as insight into the potential for protection against stroke (Table I).13–17 These study results indicate consistent trends of efficacy and safety for LAA closure, which warrant further evaluation of the Lariat in a multicenter prospective randomized trial. Sievert and colleagues17 conducted a 5-center study that evaluated the use of Lariat for patients who had contraindications to OAC therapy, such as histories of bleeding, stroke/transient ischemic attack, or cerebral aneurysm. There were 6 deaths during this study's 2-year follow-up period, one of them procedure-related because of a pulmonary embolus one day after the procedure. Sievert and colleagues' study provides promising insight into the potential of Lariat's percutaneous, nonimplant approach in high-risk patients for whom there are no other options.17 TABLE I. Efficacy and Sequelae of the Lariat Procedure14 Impact of Lariat LAA Exclusion on Atrial Fibrillation Burden Lakkireddy and colleagues18 compared the AF burden over a period of 3 months, before and after LAA ligation. Among the 18 patients in that study, the AF burden decreased from a baseline of 81% to 47% after ligation (P
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A Review of the LARIAT Suture Delivery Device for Left Atrial Appendage Closure
The Journal of Tehran University Heart Center, 2015Co-Authors: Payam Safavi-naeini, Mehdi Razavi, Mohammad Saeed, Abdi Rasekh, Ali MassumiAbstract:The prevalence of atrial fibrillation (AF) is 1-2 % in the general population, and the risk of embolic stroke in AF patients is 4-5 times higher than that in the general population. AF-related strokes are often severe, and the rate of permanent disability is much higher among individuals who have AF-related strokes than in those who have strokes unrelated to AF. In patients with AF, more than 90 % of thrombi originate from the left atrial appendage (LAA). The purpose of this paper is to review the efficacy and safety of performing the LAA closure with the LARIAT Suture Delivery Device to prevent AF-related stroke in patients with contraindications to oral anticoagulant therapy.
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Differences in Experience With a New Delivery Device for LAA Ligation Among Various U.S. Centers
Journal of the American College of Cardiology, 2015Co-Authors: Abdi Rasekh, Nitish Badhwar, Saibal Kar, Hosakote Nagaraj, Ali Massumi, Dhanunjaya LakkireddyAbstract:The Lariat Suture Delivery Device (SentreHeart, Redwood City, California) has been used to exclude the left atrial appendage (LAA). Thus far, there have not been any randomized controlled trials or large multicenter experiences reported on the Device. Price et al. made an attempt to describe their
Ali Massumi - One of the best experts on this subject based on the ideXlab platform.
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Review Article A Review of the LARIAT Suture Delivery Device for Left Atrial Appendage Closure
2016Co-Authors: Ali MassumiAbstract:The prevalence of atrial fibrillation (AF) is 1-2 % in the general population, and the risk of embolic stroke in AF patients is 4-5 times higher than that in the general population. AF-related strokes are often severe, and the rate of permanent disability is much higher among individuals who have AF-related strokes than in those who have strokes unrelated to AF. In patients with AF, more than 90 % of thrombi originate from the left atrial appendage (LAA). The purpose of this paper is to review the efficacy and safety of performing the LAA closure with the LARIAT Suture Delivery Device to prevent AF-related stroke in patients with contraindications to oral anticoagulant therapy
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A Review of the LARIAT Suture Delivery Device for Left Atrial Appendage Closure
The Journal of Tehran University Heart Center, 2015Co-Authors: Payam Safavi-naeini, Mehdi Razavi, Mohammad Saeed, Abdi Rasekh, Ali MassumiAbstract:The prevalence of atrial fibrillation (AF) is 1-2 % in the general population, and the risk of embolic stroke in AF patients is 4-5 times higher than that in the general population. AF-related strokes are often severe, and the rate of permanent disability is much higher among individuals who have AF-related strokes than in those who have strokes unrelated to AF. In patients with AF, more than 90 % of thrombi originate from the left atrial appendage (LAA). The purpose of this paper is to review the efficacy and safety of performing the LAA closure with the LARIAT Suture Delivery Device to prevent AF-related stroke in patients with contraindications to oral anticoagulant therapy.
