Heart rhythm · 2026
The SIMPLE registry: SIMplified approach for percutaneous LAA Exclusion.
СтатьяНазвание и аннотация: Перевод в очереди
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Grossi Stefano, Nentwich Karin, Hoskins Michael, Evonich Rudy, Mazer Sean, Nair Devi, Kar Saibal, Katapadi Aashish, Bianchi Francesca, Carrati Lorenzo, Shah Anand, Singh Kanwar, Fail Peter, Chandhok Sheetal, Weiner Stanislav, Wimmer Alan, Cuoco Frank, Hussaini Asma, Fan Qizhi, Rasekh Abdi, Dewland Thomas, Boldt Leif-Hendrik, Matthew Dilip, Doshi Rahul, Ahsan Syed, Knecht Jaraslava, Sonne Kai, Wong Thomas, Lee Randal J, Lakkireddy Dhanunjaya
Аннотация
BACKGROUND: Percutaneous epicardial left atrial appendage (LAA) ligation requires a series of steps and ancillary tools and is thus perceived as complex.
OBJECTIVE: In this report, we evaluate the feasibility, safety, and effectiveness of a modified approach for LAA ligation.
METHODS: This is a retrospective multicenter collection of patients who underwent a modified LAA ligation approach. Using only a pigtail LAA angiogram, the LARIAT snare was guided over the pigtail catheter to perform LAA ligation. Periprocedural and 30-day adverse events were collected. Follow-up imaging was performed 6 weeks‒3 months post ligation to assess for leaks.
RESULTS: Overall, 21 centers enrolled 104 patients (aged 71.7 ± 7.2 years; 70% male) who underwent attempted modified LAA ligation. Short-term complete LAA closure was achieved in 96.8% of patients (91/94). LAA ligation failed in 8 patients owing to adhesions. In 2 patients, ligations could not be performed with the modified pigtail approach and were converted to magnet wires, with 1 successful and 1 unsuccessful LAA ligation. The failed LAA ligation was due to a perforation of the magnet wires. There were no periprocedural complications (<7 days). In 3 patients, a delayed inflammatory pericardial effusion developed requiring pericardiocentesis, but 2 of these also underwent combined ablation. Among patients with follow-up imaging (90/104), complete LAA closure was achieved in 95.5% (86/90), and no leaks >3 mm were observed.
CONCLUSION: The evolution of the pigtail-only modified LAA ligation approach is feasible, safe, and effective at LAA closure. Future studies are still needed to assess the long-term LAA closure efficacy of this modified LAA ligation approach.
OBJECTIVE: In this report, we evaluate the feasibility, safety, and effectiveness of a modified approach for LAA ligation.
METHODS: This is a retrospective multicenter collection of patients who underwent a modified LAA ligation approach. Using only a pigtail LAA angiogram, the LARIAT snare was guided over the pigtail catheter to perform LAA ligation. Periprocedural and 30-day adverse events were collected. Follow-up imaging was performed 6 weeks‒3 months post ligation to assess for leaks.
RESULTS: Overall, 21 centers enrolled 104 patients (aged 71.7 ± 7.2 years; 70% male) who underwent attempted modified LAA ligation. Short-term complete LAA closure was achieved in 96.8% of patients (91/94). LAA ligation failed in 8 patients owing to adhesions. In 2 patients, ligations could not be performed with the modified pigtail approach and were converted to magnet wires, with 1 successful and 1 unsuccessful LAA ligation. The failed LAA ligation was due to a perforation of the magnet wires. There were no periprocedural complications (<7 days). In 3 patients, a delayed inflammatory pericardial effusion developed requiring pericardiocentesis, but 2 of these also underwent combined ablation. Among patients with follow-up imaging (90/104), complete LAA closure was achieved in 95.5% (86/90), and no leaks >3 mm were observed.
CONCLUSION: The evolution of the pigtail-only modified LAA ligation approach is feasible, safe, and effective at LAA closure. Future studies are still needed to assess the long-term LAA closure efficacy of this modified LAA ligation approach.