Long-Term Real World Experience Of Left Atrial Appendage Closure With Lariat Device In Patients With Non Valvular Atrial Fibrillation - Impact On Thromboembolism, Bleeding And Mortality

Background: Left atrial appendage closure (LAAC) with LARIAT has emerged as one of the alternatives to oral anticoagulation (OAC) in patients with non-valvular atrial fibrillation (AF). Our aim was to study long-term outcomes in patients undergoing LARIAT procedure. Methods: We analyzed patients screened for LARIAT device in 4 centers between December 2009 and December 2010. CT scan was performed in all cases as a screening process. Out of these, patients who didn’t undergo LAAC with the LARIAT device due to unfavorable LAA morphology and other pre-procedural contraindications were included in control group. We analyzed thromboembolism, bleeding events and mortality between LAA and control group. Results: Toal 153 patients were screened. Out of these, 108 (70.6%) patients underwent LARIAT placement (LAA arm) and 45 (29.4%) excluded patients were included in control arm. LAA group had higher prevalence of hypertension, CVA and heart failure. There were no differences in CHADS 2 and CHA 2 DS 2 -VASc score. Mean HAS-BLED score was significantly higher in LARIAT group (3.5 ± 1.06 vs 3.09 ± 1.22, p=0.04). Mean follow-up time (in years) was 6.56 ± 0.84 in LAA and 6.5 ± 1.26 in control arm. During follow-up period, lariat group was associated with significantly less thromboembolism (1.8 vs 24%, p = 0.001), major bleeding (4.6% vs 24%, p = 0.001) and mortality (5.6% vs 20%, p = 0.01) compared to the control group who were managed with standard medical therapy. Conclusions: Long term data in our study suggests that left atrial appendage closure with LARIAT device is an effective treatment in management of non-valvular AF patients with high risk of stroke and bleeding. LAA closure procedure with LARIAT remains to be an effective alternative approach to oral anticoagulation for the patients who are unable to take oral anticoagulation.