At a recent atrial fibrillation round table at Lewis Ginter Botanical Gardens in September, doctors from the VCU Pauley Heart Center showed a video that amazed the audience: The innovative LARIAT™ Suture Delivery System in action. In the video, a fluoroscopy from an actual procedure, two magnet-tipped catheter wires (which appear as black lines) place a loop around the left atrial appendage of a beating heart. The appendage is then sutured.
As the name implies, the LARIAT procedure “works like a lasso,” said Dr. Jay Koneru, Assistant Professor of Medicine, Division of Cardiology and Electrophysiology at Pauley. He explained that the left atrial appendage “is a redundant structure, like an appendix. It’s not needed. But blood clots formed in the left atrial appendage cause 75-90% of all strokes in afib patients.” During open heart surgery, doctors often remove the troublesome appendage from a patient as a preventive measure, he said.
The LARIAT procedure is catheter-based, with no surgery involved. The technique provides a new option for patients who are at risk of stroke but are either unable to take anticoagulants or are not good candidates for surgery. LARIAT patients require general anesthesia, and they can generally go home within 1-2 days.
Doctors at Pauley Heart Center have performed the procedure for over a year and are among the most experienced practitioners in the country.
“We’ve even had patients in their late 80s who have done very well with the procedure,” said Dr. Kenneth Ellenbogen, Chair of Cardiology and Director of the VCU Pauley Heart Center’s Atrial Fibrillation Program.