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Lariat II Suture to Close the Left Atrial Appendage

Technology & Innovations

Lariat II Suture Delivery Device

by Steve S. Ryan, updated Oct. 2016

CU of Lariat II, SentreHeart, Inc. -

Lariat II, SentreHeart, Inc.

To address the increased risk of stroke, A-Fib patients are often put on anticoagulant drug therapy, such as warfarin. Because the Left Atrial Appendage (LAA) is the source of over 90% of A-Fib-related strokes, the Lariat II Suture, an occlusion device, can be used to close off the LAA, replacing the need for anticoagulants.

It is often used in cases where the patient cannot tolerate anticoagulants like Coumadin. (The Watchman device, another occlusion device, requires a patient be on anticoagulants for several months. See The Watchman™: Alternative to Blood Thinners.)

Placement of the Lariat Device

From the inside of the heart a balloon is placed inside the Left Atrial Appendage to expand it and make it accessible to the noose device which is inserted from the outside of the heart. The positioning balloon is withdrawn before the Lariat noose is closed around the base of the Left Atrial Appendage.

The noose completely closes off the Left Atrial Appendage which dies and is no longer electrically active. The Lariat II snare device has been approved by the FDA (Lariat II, SentreHeart, Inc., Palo Alto, CA).

Video frame: Lariat being placed -

Video frame: Lariat being placed

A noose device to close off the Left Atrial Appendage is inserted from outside the heart, unlike for example the Watchman device which is inserted into the LAA from inside the heart.

The Lariat device was invented by Dr. William E. “Billy” Cohn, Director of Minimally Invasive Surgical Technology at the Texas Heart Institute at St. Luke’s Episcopal Hospital. 

VIDEO: Closure of the Left Atrial Appendage Technique 2: The Lariat Procedure. Using doctor interviews and animated footage, explains the need for and use of the Lariat occlusion device.

For more about the Lariat, see Alert: Patients with Lariat Device for Left Atrial Appendage Closure.

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Last updated: Wednesday, October 12, 2016

Watchman Occlusion Device – Blood Thinners Alternative

The Watchman device placed in opening to the Left Atrial Appendage

Illustration: The Watchman device placed in opening to the Left Atrial Appendage

The Watchman™ Device: An Alternative to Blood Thinners

By Steve S. Ryan, PhD, updated March 2015

Do you hate having to take Coumadin or other blood thinners? Hate the side effects? Or are you allergic to them? A replacement for taking blood thinners is the Watchman, an occlusion device.

The theory behind the WATCHMAN™ LAA closure technology is that most A-Fib clots originate in the Left Atrial Appendage (LAA). The Watchman closes off the LAA where 90%-95% of A-Fib strokes come from. It’s a very low risk procedure that takes as little as 20 minutes to install. Afterwards, you would usually not need to be on blood thinners.

Added 4/19/2018: Anticoagulants increase the risk of intracerebral hemorrhages (ICH), a less common but more deadly and disabling type of stroke. Over 50% of patients who have a warfarin-related ICH die within the first three months. The Watchman, however, considerably decreases ICH risk by over 50%, even when compared to NOACs.1

Boston Scientific's WATCHMAN™ LAA closure technology

Boston Scientific’s WATCHMAN™ LAA closure technology

How It Works

The Watchman device comes in multiple sizes from 21mm to 33mm to accommodate the different sizes of LAAs. Once a patient’s Left Atrial Appendage is measured, a wide-sheathed catheter with a spline is used to insert the Watchman device which has a self-expanding Nitinol (a special metal) open-ended circular frame.

The atrial surface of this frame is covered with a thin, permeable 160 μm (micron) pore filter made of polyester material (Polyethylene Terephthalate known as Dacron or PET). This filter allows blood to pass through while stopping clots. Little hooks or anchors called fixation barbs at the middle of the device make sure it is attached firmly to the LAA wall.

Before the catheter is removed (which fixes the Watchman in place), contrast agents are used to make sure the Watchman is stable and closes off the LAA opening. Over time heart tissue grows over the polyester (PET) material so that it completely closes off the LAA with smooth heart tissue similar to other heart surfaces.

In this Occlusion image, heart tissue has completely covered the Watchman device after only nine months. 

Anatomical View of the WATCHMAN Device in the LAA 9 months after implantation.

Patients on Coumadin continue to take it for six weeks after the Watchman device is inserted. They are then examined using a TEE (Transesophageal Echocardiogram) to make sure there is complete closure of the LAA. At that time they are taken off of Coumadin and put on a different type of blood thinner called clopidogrel (Plavix) until six months after the implant procedure. 

Think of the Watchman as a replacement for blood thinners; both reduce but do not totally eliminate the risk of stroke. The stroke risk is reduced to that of a person with a normal heart.

Even while you are waiting for or trying to decide on having a Pulmonary Vein Ablation, you can have the Watchman inserted and reduce your stroke risk to that of a person without A-Fib.

The Future

Just as closing off the LAA is standard practice in the Cox Maze/Mini-Maze operations, in the future, the Watchman device could become part of most catheter ablation procedures. If included with the ablation procedure, the Watchman would protect the patient from blood clots even if the catheter ablation procedure was unsuccessful. 

And the Watchman device may become standard therapy for anyone at risk of a stroke, not just for people with A-Fib.

For a list of US doctors installing the Watchman device, go to Steve’s Lists/Doctors Installing the Watchman Device.

Update: The U.S. Food and Drug Administration (FDA) approved Boston Scientific’s WATCHMAN™ LAA closure technology for use in the U.S. on March 13, 2015. It has been available internationally since 2009. The FDA approval of the WATCHMAN device is based on the clinical program which consists of numerous studies, with more than 2,400 patients and nearly 6,000 patient-years of follow-up. The Watchman device will be available first at U.S. centers where it has been used in clinical studies. 
Reference for this Article
Sick, PB. Initial Worldwide Experience With the WATCHMAN Left Atrial Appendage System for Stroke Prevention in Atrial Fibrillation. Figure 5. Journal of the American College of Cardiology. Volume 49, Issue 13, 3 April 2007, Pages 1490–1495. Last accessed Jan 10, 2013 URL:

Posted December 2012, updated April 2018

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Footnote Citations    (↵ returns to text)

  1. Gurol, M Edip. Brain MRI scans can inform the choice between OACs and LAA closure for non-valvular AF. Cardiac Rhythm News. March 18, 2018, Issue 40. p. 9.

US Doctors Installing the Watchman Device – a List by

If you are at high risk for stroke but can’t or don’t want to take anticoagulants, your doctor may suggest closing off the Left Atrial Appendage using an FDA approved occluder such as the Boston Scientific WATCHMAN™ device.

Who’s Installing the Watchman? Boston Scientific offers a database of medical centers implanting WATCHMAN, but there may be additional medical centers in your area that are not listed here.

My Recommendations: To install your Watchman device, I highly recommend selecting an electrophysiologist (EP) that is also certified in “Clinical Cardiac Electrophysiology”. The following list of EPs meet this criteria and is offered as a service to our readers.

NOTICE: Unlike some other directories we offer no preferential listings and accept no fee, benefit or value of any kind for listing a specific doctor or medical center, nor are we associated with any practice, medical center or physician.

Alabama Birmingham Dr. Jose Osorio 205-939-0073 Alabama Cardiovascular
Arizona Phoenix, Peoria, Chandler Dr. Vijendra Swarup (Clinical Trial Participant) 602-456-2342 Arizona Heart Rhythm Center
Arizona Phoenix Dr. Marwan M. Bahu 602-952-0002 Biltmore Cardiology
Arizona Phoenix Dr. Ashish Sadhu 602-307-0070 Heart & Vascular Center
California Santa Monica Dr. Shephal Doshi (Clinical Trial Participant) 310-829-6889  St. John’s Health Center
California Los Angeles Dr. Michael Shehata 310-423-3336 Cedars-Sinai
California Los Angeles Dr. Ivan Ho 213-977-0419 Good Samaritan
Florida Atlantis Dr. Mark A. Freher 561-434-0353 Florida Electrophysiology Assoc.
Florida Bradenton Dr. Daniel E. Friedman 941-748-2277 Bradenton Cardiology
Forida Lakeland Dr. Neal G. Kavesh 863-680-7000 Watson Clinic
Florida St. Petersburg Dr. Robert C. Sheppard 727-490-2136 Heart & Vascular Institute
Florida St. Petersburg Dr. Shalin S. Shah 727-544-1441 Bay Area Heart Center
Florida Sarasota Dr. Robert E. Eckart 941-917-4250 Heart Specialists of Sarasota
Florida Sarasota Dr. Dilip J. Mathew (Lariat) 941-486-6758 Heart Rhythm Consultants
Florida Tallahassee Dr. Farhat S. Khairallah 850-216-0120 Southern Medical Group
Florida Tampa Dr. Kevin J. Makati (Lariat) 813-229-9292 Tampa Cardiac Specialists
Georgia Atlanta Dr. Angel Leon (Clinical Trial Participant) 404-686-2504 Emory Univ. Heart Center
Georgia Atlanta Dr. David DeLurgio (Clinical Trial Participant) 404-686-2504  Emory Univ. Heart Center
Georgia Atlanta Dr. Mikhael F. El-Chami 404-686-2504 Emory Univ. Heart Center
Georgia Atlanta Dr. Michael Hoskins 404-712-4063 Emory Univ. Hospital
Illinois Naperville, Winfield Dr. Moeen A. Saleem 630-687-9451 Midwest Heart Specialists
Illinois Springfield Dr. Ziad F. Issa (Clinical Trial Participant) 217-788-0706 Prairie Cardiovascular Consultants
Kentucky Lexington Dr. Gery Tomassoni (Clinical Trial Participant) 859-277-5887 Lexington Cardiology at Central Baptist
Massachusetts Boston Dr. Moussa Mansour (Clinical Trial Participant) 617-726-5557 Massachusetts General Hospital
Massachusetts Burlington Dr. Bruce G. Hook 781-744-8863 Lahey Clinic
Massachusetts Burlington Dr. Jonathan S. Silver 781-744-8863 Lahey Clinic
Massachusetts Fall River Dr. Nitesh A. Sood 508-679-7262 Southcoast Healthcare 
Michigan Detroit Dr. Claudio D. Schuger 313-916-2417 Henry Ford Hospital
Michigan Grand Rapids Dr. Musa I. Dahu 616-885-5000 Frederik Meijer Heart
Michigan Royal Oak Dr. David E. Haines 248-898-4198 William Beaumont Hospital
Minnesota Minneapolis Dr. William Katsiyiannis (Clinical Trial Participant)  612-863-3900 Minneapolis Heart Institute
Minnesota Rochester Dr. Douglas L. Packer 507-284-3994 Mayo Clinic
Minnesota Rochester Dr. Samuel J. Asirvatham 507-284-3994 Mayo Clinic
Minnesota Rochester Dr. Thomas M. Munger 507-284-3994 Mayo Clinic
Mississippi Tupelo Dr. Karl J. Crossen 662-620-6800 Cardiology Assoc of Northern Mississippi
Mississippi Tupelo Dr. Keith Kyker 662-620-6800 Cardiology Assoc of Northern Mississippi
Missouri Kansas City Dr. Alan Wimmer (Clinical Trial Participant) 816-931-1883 Mid America Heart Institute
Missouri Saint Louis Dr. Amit A. Doshi 314-256-5240 Heart Health Center
Missouri Saint Louis Dr. J. Mauricio Sanchez 314-993-6969 Heart Health Center
New Hampshire Manchester Dr. Connor J. Haugh 603-669-0413 Catholic Medical Center
New Hampshire Manchester Dr. Jamie H. Kim 603-669-0413 Catholic Medical Center
New Jersey Asbury Park Dr. Ashish B. Patel 732-663-0300 Monmouth Cardiology
New Jersey Camden Dr. Zoltan Turi 856-968-7096 Cooper Univ. Hospital
New Jersey Neptune Dr. Mark A. Mascarenhas 732-776-8535 Monmouth Cardiology
New Jersey Neptune Dr. Mark J. Hansalia 732-776-8500 Shore Heart Group
New Jersey Parlin Dr. Zyan Younan 732-727-0400 K. George Younan, MD
New York New York Dr. Vivek Reddy (Clinical Trial Participant) 212-241-7114 Mount Sinai
New York Manhasset Dr. Stuart J. Beldner 516-562-2300 North Shore Univ. Hospital
New York New Hyde Park Dr. Bruce G. Goldner 718-470-7330 Long Island Jewish Medical
New York New Hyde Park Dr. Apoor Patel 718-470-7330 Long Island Jewish Medical
New York New York Dr. Srinivas R. Dukkipati 212-241-7114 Mount Sinai
New York New York Dr. Jacob Koruth 212-241-7114 Mount Sinai
New York Staten Island Dr. Marcin Kowalski 718-663-7000 Staten Island Univ. Hospital
North Carolina Charlotte Dr. John W. Holshouser 704-373-0212 Sanger Heart & Vascular
Ohio Cleveland Dr. Mohamed Kanj 216-444-9162 Cleveland Clinic
Ohio Cleveland Dr. Walid Saliba 216-444-9162 Cleveland Clinic
Ohio Cleveland Dr. Oussama M. Wazni 216-444-9162 Cleveland Clinic
Ohio Columbus Dr. James M. Kleman 614-262-6772 OhioHealth Heart
Tennessee Nashville Dr. Robert A. “Drew” Pickett 615-329-5144 Saint Thomas Midtown
Tennessee Nashville Dr. W. David Thompson 615-269-4545 Saint Thomas West
Tennessee Nashville Dr. Christopher R. Ellis 615-322-2318 Vanderbilt Heart Center for Atrial Fibrillation
Texas Austin Dr. Rodney Horton (Clinical Trial Participant) 512-807-3150 Texas Cardiac Arrhythmia Institute
Texas  Austin Dr. Andrea Natale 512-807-3150 Texas Cardiac Arrhythmia Institute
Texas  Austin Dr. J. David Burkhardt 512-807-3150 Texas Cardiac Arrhythmia Institute
Texas Austin Dr. Patrick M. Hranitzky 512-807-3150 Texas Cardiac Arrhythmia Institute
Texas Austin Dr. David R. Tshopp 512-458-1006 Austin Heart
Texas Fort Worth Dr. Syed Nayyar Shah 817-334-2800 Heart Center of North Texas
Texas Fort Worth Dr. Senthil K. Thambidorai 817-334-2800 Heart Center of North Texas
Texas Houston Dr. Nadim Nasir, Jr. 713-791-1978 Methodist DeBakey Heart
Texas Houston Dr. Miguel Valderrabano 713-791-1978 Methodist DeBakey Heart
Texas San Antonio Dr. Kiran N. Jayaram 210-614-5400 Cardiology Clinic of San Antonio
Utah Murray Dr. J. Peter Weiss 801-507-3513 Intermountain Heart
Virginia Richmond Dr. John R. Onufer (Clinical Trial Participant) 804-288-4494 Virginia Cardiovascular Specialists
Virginia Norfolk Dr. Ian Woollett 757-597-9294 Sentara Cardiovascular Research
Washington  Seattle Dr. Adam Zivin 206-861-8550 Swedish Heart & Vascular
Washington Seattle Dr. Jordan Prutkin 206-598-4300 UW Medicine Regional Heart Clinic
Wisconsin Madison Dr. Michael Field 608-265-4188 Un. of Wisconsin Hospital & Clinics

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