Issue link: https://viewer.e-digitaledition.com/i/196089
About dr. ziv Born in Israel but raised in New York, Dr. Ziv came to the U.S. in 1979 with his parents and three brothers — two of whom are now also physicians. He earned a BS degree in Biology from Yale, followed by an MD degree from University of Pittsburgh Medical School before returning to New York in 2001 for an internship and residency training at Columbia Presbyterian Hospital. Over the next six years Dr. Ziv received fellowship t ra ining in Cardiovascular Disease, Clinical C a rd iac E le c t rophy siolo g y a nd Advanced Ablation Electrophysiology at Brown University School of Medicine, Rhode Island Hospital. While there, he also served as an American Heart Association Research Postdoctoral Fellow, a n instr uctor at Brow n University School of Medicine, and an electrophysiologist at Rhode Island Hospital. In addition, he was (and still is) a reviewer for the American Journal of Cardiology and the Heart Rhythm Journal. In 2010, he moved to Cleveland and joined The MetroHealth System. "I was recruited by Dr. David Rosenbaum, the past Director of iLLuStratioN by mike muStar, meDiCaL iLLuStrator, metroheaLth, CLeveLaND Alternative treatments for these patients were mostly limited to open heart surgery to excise the LAA. Three newer options developed over the last 10 years take a much less invasive, percutaneous approach. Two involve implants placed via catheters in the left atrium to block off or plug the LAA. The third also utilizes catheters, but not to place anything in the heart. Instead it delivers to the outside of the heart a pre-tied suture loop, like a lariat, to tie off the LAA. Appropriately called the Lariat Suture Delivery Device, it was used for the first time in Northern Ohio in April 2013 at MetroHealth. Dr. Ziv performed the procedure. The Lariat Procedure Cardiology at MetroHealth. He passed away a little over a year ago. David was an internationally known electrophysiologist and a cutting-edge researcher," says Dr. Ziv. "I had previously read all of his papers, so I jumped at the chance to work with him." He explained that Dr. Rosenbaum was looking for someone who could translate basic research findings to the clinical electrophysiology lab. "David's goal was to use the innovations and insights from research and make the transition from the bench to the bedside much faster to help patients. The Lariat is a good example of that." The Lariat The Lariat procedure involves guiding two catheters to the inside and outside of the heart. One enters through the femoral vein into the left atrium; the other, through the pericardium via a 3 mm incision just under the rib cage. From each catheter, a wire with a magnetic tip is advanced to the LAA. When the magnets connect, the Lariat Suture Delivery Device is advanced. The wires are then pulled back, and a suture is deployed from the Lariat around the LAA to tie it off. With the LAA closed, blood cannot enter and clots cannot form, reducing the risk of stroke. "The most difficult part of the procedure is gaining access to the heart through the pericardium. We use transesophageal echocardiography and fluoroscopy for visualization," says Dr. Ziv. "Each aspect of the access on its own is something that electrophysiologists have done for at least 10 years. We have been accessing the dry pericardium for ablations of ventricular tachycardia." There are technical issues associated with the suture, as well. The delivery must be very precise, and the suture knot must be securely tightened. The Lariat facilitates both. A collapsible snare retains the suture until it's ready to be deployed. It opens and closes as needed to confirm placement before releasing the suture. To ensure consistency in tightening of sutures and NovEmBEr /dECEmBEr ■ mdNEWS.Com ■ MD News Cleveland/Akron/Canton | 11