{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,28]],"date-time":"2026-07-28T20:23:49Z","timestamp":1785270229599,"version":"3.55.0"},"reference-count":36,"publisher":"Wiley","issue":"8","license":[{"start":{"date-parts":[[2021,7,7]],"date-time":"2021-07-07T00:00:00Z","timestamp":1625616000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Cardiovasc electrophysiol"],"published-print":{"date-parts":[[2021,8]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Introduction<\/jats:title><jats:p>The LARIAT epicardial suture snaring device has been fraught with technical challenges and procedural complications. Over time, technique modification and improved operator experience have helped overcome many of these challenges.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods\u00a0and Results<\/jats:title><jats:p>Studies reporting left atrial appendage epicardial closure over a 12\u2010year period from 2009 to 2020 were evaluated. The primary efficacy outcome evaluated was left atrial appendage closure with residual flow \u22641\u2009mm. Safety outcomes evaluated were periprocedural and long term complications after device placement. Nine studies consisting of 1430 patients were included in this analysis, of which 1386 (97%) underwent successful device placement. The mean age was 69.3 years, with a mean CHADS<jats:sub>2<\/jats:sub>\u2010VASC score of 3.78. Primary efficacy end point was achieved in 95.8% patients immediately after device placement, and in 92.8% patients on long term follow\u2010up. Early procedural complications consisted of pericardial effusion 5.6%, cardiac perforation 2.7%, pericarditis 2.6%, and need for open heart surgery 1.5%. Long term complications consisted of all\u2010cause mortality 2.3%, stroke 1.5%, and left atrial appendage thrombus 2.3%. Reduced complications were noted using micropuncture needles (2.20% vs. 10.14%; <jats:italic>p<\/jats:italic>\u2009&lt;\u2009.0001), a longer duration pericardial drainage, and use of anti\u2010inflammatory medications (1.58% vs. 8.4%). Oral anticoagulation use decreased from 44.7% to 22.9% post device implantation, and to 8.5% on last clinical follow up.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>The LARIAT device is effective in epicardial closure of the left atrial appendage. Improvement in device techniques such as use of micropuncture needle, prophylactic colchicine, and maintenance of a pericardial drain have helped improve safety over time.<\/jats:p><\/jats:sec>","DOI":"10.1111\/jce.15132","type":"journal-article","created":{"date-parts":[[2021,6,24]],"date-time":"2021-06-24T02:58:35Z","timestamp":1624503515000},"page":"2189-2198","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Safety and efficacy of left atrial appendage closure using an epicardial suture snaring device: Systematic review and current status"],"prefix":"10.1111","volume":"32","author":[{"given":"Syed Rafay Ali","family":"Sabzwari","sequence":"first","affiliation":[{"name":"Department of Electrophysiology University of Colorado Aurora Colorado USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5971-2158","authenticated-orcid":false,"given":"Nikhil A.","family":"Mehta","sequence":"additional","affiliation":[{"name":"Department of Cardiology Lehigh Valley Health Network Allentown Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9387-4369","authenticated-orcid":false,"given":"Lohit","family":"Garg","sequence":"additional","affiliation":[{"name":"Department of Electrophysiology Hospital of the University of Pennsylvania  Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lekha","family":"Racharla","sequence":"additional","affiliation":[{"name":"Department of Cardiology Lehigh Valley Health Network Allentown Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emilee","family":"Kurtz","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine Lehigh Valley Health Network Allentown Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3343-7618","authenticated-orcid":false,"given":"Muhammad R.","family":"Afzal","sequence":"additional","affiliation":[{"name":"Department of Electrophysiology Ohio State University Columbus Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohit K.","family":"Turagam","sequence":"additional","affiliation":[{"name":"Department of Electrophysiology The Mount Sinai Hospital New York City New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dhanunjaya","family":"Lakkireddy","sequence":"additional","affiliation":[{"name":"Department of Electrophysiology Overland Park Regional Medical Center Overland Park Kansas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2021,7,7]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.285.22.2864"},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.1378\/chest.09-1584"},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2018.05.048"},{"key":"e_1_2_10_5_1","doi-asserted-by":"publisher","DOI":"10.1002\/ccd.22764"},{"key":"e_1_2_10_6_1","doi-asserted-by":"publisher","DOI":"10.1002\/ccd.25004"},{"key":"e_1_2_10_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2015.04.025"},{"key":"e_1_2_10_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2015.06.028"},{"key":"e_1_2_10_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2012.06.046"},{"key":"e_1_2_10_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2014.03.057"},{"key":"e_1_2_10_11_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamainternmed.2015.1513"},{"key":"e_1_2_10_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjcard.2012.11.061"},{"key":"e_1_2_10_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.hrthm.2014.07.032"},{"key":"e_1_2_10_14_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacep.2015.08.005"},{"key":"e_1_2_10_15_1","doi-asserted-by":"publisher","DOI":"10.1002\/ccd.25065"},{"issue":"5","key":"e_1_2_10_16_1","first-page":"1030","article-title":"Short and long\u2010term outcomes of percutaneous left atrial appendage suture ligation: Results from a US multicenter evaluation. 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