LAAO - Surrey meeting Feedback

As promised, here is some feedback from Dr John Foran's presentation as the Surrey ASG meeting this evening. Please understand that I have no medical training and that this feedback is based on my interpretation of what we were told.

Dr Foran explained the importance of anti-coagulation and the various options available to AF sufferers such as Warfarin and NOACS. He then described an alternative procedure - Left Atrial Appendage Occlusion and provided several statistics relating to procedures undertaken at the Royal Brompton and Harefield Hospitals since 2009. Details of these statistics will be sent to the meeting attendees and subject to approval, should be available to interested parties later. We were told that stroke protection was considered to be better than using conventional oral anti-coagulation.

Apparently, 90% of potential clots are formed in the Appendage, with the remaining 10% forming elsewhere in the Left Atrium. The procedure itself takes less than an hour and follows a similar process to a Catheter Ablation, however, the total time including preparation and recovery could be around 4 hours and may require an overnight stay. Patients are carefully monitored during the procedure to determine that the Appendage has been successfully sealed. The time patients have to remain on anti-coagulation is dependent upon the success of the sealing process and the time it then takes for a natural skin to develop and finally seal the area. In extreme cases, this may take a year, but more normally 3 to 6 months.

The success rates for the procedure were impressive, with no serious failures. However, access to the procedure is restricted to patients who are unable to take any form of oral anti-coagulation medication. This generally means patients who have experienced severe life threatening bleeding and/or serious heart conditions. Recently, funding for this procedure has transferred from local to central government control. Any request for a procedure is generated by the medical team and there is a formal process which has to be followed before funding is agreed. We were told that there may be changes taking place in the USA which may influence similar changes in the UK but that this may take time to materialise. Privately funded or health insurance funded procedures are unlikely to proceed because they are subject to the same criteria.

In summary, this is a successful procedure that will protect patients against the risk of stroke who cannot take conventional anti-coagulation medication, although this may change over time.

I hope this helps to answer some of the questions raised earlier.

John

[Rellim296]

Cheers, John - a prompt and informative resume. It rather sounds as if I wouldn't be a candidate though, as I can take warfarin (somewhat unsuccessfully) and could take a NOAC. I just dislike losing my usual coagulative abilities and feel I am at risk. I know there's protection from stroke, but it doesn't comfort me.

[Hidden in reply to Rellim296]

I was thinking of you as I was rattling the keys!!!! Sorry its not giving you the answer you wanted

John

[Rellim296 in reply to Hidden]

Well, we'll see. I am hoping to discuss it with my EP. I've been in touch with his secretary. The prospect of possibly being safe and not needing anticoagulation has put me in a good mood for a few days! I could see a satisfactory way ahead. I do hate the feeling that I'm departing from the norm by taking warfarin and, with a wandering INR, it feels so hit and miss. I am convinced that I'm one of the few for whom it turns out that anticoagulation was a bad idea. If there's a 85% / 15% split in anything, I so often find myself in the minority group. The split between rhesus positive and negative is about 83% / 17% and I'm one of the non conformists. Less than 1% of the population has my blood group. Same thing with mitochondrial DNA. Nice to be different, but it can be a bit unsettling so anticoagulation bothers me. Although a low INR isn't that good, I'm happier (or less unhappy) when I'm down at the bottom of the therapeutic range.

[Hidden in reply to Rellim296]

Hope your discussion with your EP goes well

John

[Hidden in reply to Rellim296]

Rellim,

Dr Foran did make it clear that only a very small percentage of people on warfarin have experienced serious, life threatening bleeds. He also said that it can help to make a much earlier diagnosis for some cancers, such as bladder or bowel, if blood is detected in urine or stools.

I'm not sure if this helps you.

Best wishes, John

[Rellim296 in reply to Hidden]

Yes, both points noted. Thank you! It's as much the accidental opportunities to bleed that worry me and I no longer walk anywhere remote and don't go out on my own. In the last five years and before I started taking warfarin I've had two incidents while out walking alone that might have been very much worse had they occurred where there was no phone signal.

[BobD Volunteer in reply to Hidden]

Very true John as one who has had cancer can tell.

[Hidden]

Much appreciated John as I couldn't make it last night.

[rosailor]

Thanks for posting the feedback from the meeting John

Good to know there is an alternative to taking drugs to help prevent blood clots forming in our hearts.

I wonder if the Left Atrial Appendage Occlusion serves no useful purpose, similar to our gut appendix? and is therefor yet another extra bit we don't need.

or it's purpose could be to store an extra short supply of blood for, say during a severe bleeding trauma, and could thus helping to prevent an air bubble forming in our blood circulation system, or something of that nature. It would be interesting to find out

[Hidden in reply to rosailor]

All I can say rosailor is that Dr Foran did make a comparison between the value of the Left Atrial Appendage and the appendix!

[Barb1]

Thank you Flapjack

[Hidden in reply to Barb1]

My pleasure Barb1.....reference one of your earlier posts, we did ask if they could perform a LAAO at the same time as a Catheter Ablation. Whilst technically this is apparently possible, they do not combine the procedures. The reason being that if a further Catheter Ablation is needed, they may need access to the appendage and if it is sealed this will make the procedure very complex.

[Barb1]

Thank you for asking the question. So the LAAO is to prevent clots forming in the appendage but if you have one then you can't have any future ablations? Or it may be that any future ablations have less chance of success?

[Hidden in reply to Barb1]

Interesting question!!

[porridgequeen]

Thanks John (and Rosemary) very interesting.

[BobD Volunteer]

Thank you John for sending me the slides. It isn't that easy to get the full effect without the sound track of course! For those who haven't seen it , the talk was specifically about the Watchman Device which has been around a few years and is only one of several such ideas in this area. Removal of the LAA is another possibility which I have mentioned before but only performed by a very few specialists in UK unless during open heart surgery. The Watchman was heralded as a great breakthrough when it first appeared but from the talk it it seems that use is severely restricted to a particular small number of patients so it is important not to raise peoples hope regarding the possibility of stopping anticoagulation which is still so vital to most of us.

I am sure that I recently read of some concern about LAAO with the thought that this apparently un-required little piece of our hearts is actually quite important but can't recall what for. There are lots of bits of us we can live without after all.

Thanks Rosemary and John for spreading the word.

Bob