Left atrial appendage tachycardia termination with A LARIAT suture ligation

Left atrial appendage (LAA) is a known trigger for left atrial tachycardia (AT). The use of LARIAT epicardial suture for termination of AT arising from LAA is not yet reported. A 66-year-old female had a history of hypertension, diabetes, sick sinus syndrome, labile INR, and symptomatic persistent AF. She underwent radiofrequency ablation after failed cardioversion and multiple antiarrhythmics. She was in AT originating from LAA on activation map. Radiofrequency endocardial LAA isolation was performed. However, the AT recurred with increased burden and symptoms. Due to her multiple hospitalization for spontaneous bleeds and labile INR, a Lariat epicardial suture ligation of her LAA was performed. With application of the Lariat suture, electrical isolation was achieved and the AT terminated. She remained AT free at 18 months. Our case is the first to illustrate the utility of LARIAT suture in electrical isolation of the LAA in addition to its mechanical exclusion.