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Atrial fibrillation (AF) increases by fivefold a patient's risk for thromboembolic stroke. The main source of emboli in AF is the left atrial appendage (LAA). Therefore, LAA closure could reduce the risk for thromboembolic events in AF. The investigators report the first United States experience with a novel percutaneous LAA closure device, the Lariat snare device, and its outcomes in 21 patients with AF, CHADS2 scores ≥2, and contraindications to anticoagulation. The LAA was closed with a snare containing suture from within the pericardial space. The intraoperative success of the procedure was confirmed by left atrial angiography and transesophageal echocardiographic color Doppler flow. The effectiveness of the procedure was evaluated by follow-up transesophageal echocardiography. The incidence of periprocedural and short-term complications was assessed by reviewing medical records. Twenty patients (100%) had successful LAA exclusion that was preserved at 96 ± 77 days. No patient had a stroke during an average of 352 ± 143 days of follow-up. One patient had right ventricular perforation and tamponade that required surgical exploration and repair. Two patients required prolonged hospitalization: 1 because of pericardial effusion that required repeat pericardiocentesis and 1 because of noncardiac co-morbidities. Three patients developed pericarditis <1 month after the procedure, of whom 1 had associated pericardial effusion that required drainage. In conclusion, percutaneous LAA exclusion can be achieved successfully and with an acceptable incidence of periprocedural and short-term complications. Further studies are needed to determine whether LAA exclusion lowers the long-term risk for thromboembolic events in patients with AF and contraindications to anticoagulation., (Copyright © 2013. Published by Elsevier Inc.)

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. [ABSTRACT FROM AUTHOR]