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Dr. Devi Nair
2024 AF Symposium
A Case of Closing Off the LAA with the LAMINAR Device with Pre-Recorded Video
Dr. Devi Nair from St. Bernards Medical Center in Jonesboro, AR presented a pre-recorded case of Left Atrial Appendage closure using the LAMINARLAA device (Johnson and Johnson/Biosense Webster).
Closing off the Left Atrial Appendage (LAA) is increasingly necessary in more complicated cases of A-Fib ablation. If for whatever reason the LAA is no longer contracting or pumping out properly, clots can form and cause a stroke. (Some advocate that the LAA should be routinely closed off in all A-Fib patients to prevent a stroke, because 90% to 95% of clots come from the LAA.)
Click to open ANIMATION: LAMINAR LAA closure device
Using the LAMINAR Device
In a pre-recorded case, Dr. Nair worked on a patient who needed their LAA closed off. In the upper left frame of this slide, the LAMINAR catheter is shown with the ball extended which is used to close off the LAA.
We saw Dr. Nair using Ultrasound and TEE (3D) to position the ball into the ostium of the patient’s LAA. The ball has tiny hooks which grab the LAA ostium walls. Currently, there are two sizes of the ball―12mm and 16 mm to fit into different patient’s anatomy. (More sizes are in development.)
The LAMINAR catheter device; (Upper left frame) the LAMINAR catheter is shown with the ball extended which is used to close off the LAA.
Laminar LAA Closure/Elimination Device
Once the ball is properly positioned, the table top device above is used to rotate the ball counterclockwise to “plicate” or twist the LAA till it closes. The black knob is used to twist the ball in graded increments. The numbers tell the operator the degree of rotation (15-20°at a time). Dr. Nair described the table top device as very stable and that it allows very precise movements. It locks in place after a particular rotation.
Dr. Nair said that she could step away if she wanted to and that the table top device lets her operate at times hands free. Dr. Nair explained that the ball does not and should not touch the back of the LAA. The whole process takes 16 minutes with testing taking only 60 seconds done in real time.
Laminar 45 day pre and post implant
Repositioning the LAMINAR Device
While we were watching, Dr. Nair wasn’t happy with the first positioning and rotation of the ball. She simply released the mechanism allowing the LAA to return to its normal position. Then she started the process again.
The Disappearing LAA
Once Dr. Nair had positioned the catheter ball properly and twisted the LAA shut, she locked it in place after testing for leaks with a contrast agent.
Comparing Watchman (left) Amulet (center) Laminar (right) occlusion devices.
To those of us watching, it looked like the LAA had basically disappeared. Dr. Nair showed a slide of the LAA pre and post 45-day implant where the LAA was removed. Only a very small ball is left inside the LAA after it is closed off.
Dr. Nair also showed how the size of the closed off LAMINAR compares to the protrusions of the installed Watchman FLX and Amulet LAA closure devices.
The LAMINAR LAA closure/elimination device has been used in Europe for 3 years and is now in its third generation. European patients have had as many as 3 years of follow-up. In the U.S., it’s currently in clinical trials and aims to enroll 1,500 patients across up to 100 sites.
Editor’s Comments
Editor’s CommentsExperts Already Using the LAMINAR LAA Closure Device: I was surprised at how many of the expert panelists and other operators were already familiar with and using the LAMINAR LAA closure device, including Dr. Vivek Reddy of Mount Sinai in New York. Dr. Reddy explained that the anatomy of the patient’s LAA really doesn’t matter, as long as the device doesn’t touch the posterior wall of the LAA.
To me the LAMINAR device looks full proof, but of course we will have to wait on clinical trials and real-world experience to see how it works out in practice.
Medical Breakthrough! The Laminar LAA elimination device is a potential medical breakthrough innovation!
Click to open ANIMATION: LAMINAR LAA closure device
