Epicardial ligation of the left atrial appendage: Long-term results in patients with high stroke and bleeding risk

Introduction: Left atrial appendage (LAA) closure may be performed in atrial fibrillation (AF) patients with contraindications for anticoagulation and high stroke risk. Multiple trials have proven non inferiority of endocardial LAA occlusion in terms of total stroke events versus oral anticoagulation, while epicardial LAA exclusion at the time of open heart surgery has led to a decrease in embolic stroke events. In our center percutaneous LAA ligation using the Lariat device is the primary technique for LAA closure since long-term antithrombotic medication is not needed. Long-term safety and efficacy of percutaneous epicardial ligation appears favorable, but there is a lack of evidence of stroke prevention. We present follow-up data up to 6 years of a large single center group of AF patients with contraindications to oral anticoagulation (OAC) therapy undergoing the LARIAT procedure.