Lariat Procedure

The LARIAT procedure involves the minimally invasive suturing of the left atrial appendage, or LAA, which is primarily responsible for the increased stroke risk that Atrial Fibrillation or Afib patients experience. The LAA is an outpouching from the heart, not too dissimilar from the appendix in the colon. The irregular heartbeats associated with Afib can cause blood to pool and clot within the LAA. If any of these clots were to break off, they could travel to the brain and cause a stroke. While many patients are prescribed anticoagulants, colloquially known as blood thinners, to manage the risk of stroke, about 50% will experience side effects of the medication and require alternate intervention.

How we close the LAA

Traditionally, open heart surgery was necessary to seal or occlude the LAA, but more recently minimally invasive procedures such as the LARIAT and the Watchman device have been employed with similarly effective results and far lower invasiveness and risk.

The LARIAT is a catheter-based suturing procedure, meaning that traditional surgery is not required. Two catheters are inserted into the body. The first is threaded under the rib cage and contains the suturing system. The second is guided to the LAA using advanced imaging. This second catheter allows the LARIAT suture to be placed appropriately.

The system allows for a precise application of a suture loop around the base of the LAA. Once the loop is tightened, it permanently closes off the LAA from the rest of the heart and eliminates blood flow to the appendage. Over time, the LAA shrinks, ultimately becoming scar tissue. This eliminates the risk of blood clots forming and dislodging from within the LAA.

Benefits of the LARIAT suturing procedure

• We have seen a success rate of about 95% with the LARIAT procedure, with patients able to eliminate their long-term use of anticoagulants.
• This is a non-surgical, minimally invasive procedure that avoids open heart surgery.
• There are fewer risks of complications, including blood loss, pain and infection.
• The procedure is curative, meaning that it is permanent and addresses the source of the problem.
• The elimination of the LAA does not affect the function of the rest of the heart.
• No occlusion device is left behind, only a small suture.

Risks of the LARIAT

• As with any procedure that punctures the skin, there is some risk of pain, blood loss and infection
• Because the LARIAT uses catheter technology, there is some risk to the blood vessels and the heart structure, which can be mitigated by an experienced electrophysiologist
• While complete occlusion is achieved in most patients, there is a small risk of leakage which can allow a blood clot to travel to the brain and cause a stroke
• Some patients may not be able to completely eliminate their anticoagulant medication

The bottom line

Along with the Watchman device, patients have more options than ever to reduce the risk of stroke as a result of Afib, and in particular, blood pooling in the left atrial appendage. Please schedule a consultation with our electrophysiologists to learn more about these minimally invasive procedures and how they may benefit you.