Electrical and Morphologic Characteristics of the Left Atrial Appendage Remnant After an Incomplete Exclusion Using Lariat Device

Background: Left atrial appendage (LAA) is incompletely excluded in some patients after a Lariat ligation. We describe the electrical and mechanical characteristics of these left atrial appendage remnants (LAARs). Methods: We studied a total of 78 patients with persistent atrial fibrillation who had a Lariat LAA exclusion procedure at the participating institutions followed by atrial fibrillation ablation. Patients underwent a combination LAA ligation and AF ablation. We studied the morphology of the LAA pre and post ligation using CT scans or TEE or LA angiogram. Electrical characteristics of the LAA were assessed during ablation. Results: Nine patients (mean age of 73 yrs, 70% males) had an incomplete exclusion (12%) with a central leak ranging from 1-5 mm. There was no significant difference in the recurrence rates between the patients who had a leak versus those who did not (3 of 9[33%] vs. 22 of 68 [35%]; p = 1.0). The LAA size reduced by 66% (mean 35±9 cc to 12±8 cc). In patients (n = 5) with a leak...