Af stroke risk fix?

[Jackieboy55]

Interesting on BBC South Today yesterday, possible remedy for af stroke risk. It is a procedure to plug top corner of left atrium to prevent clot from leaving and travelling around bloodstream. Worth watching , if you can get it on catch up.

[Jackieboy55]

Sorry, just to be clear, it was 30th, 6.30 one, after main news.

[jimmysouthgates]

There's a story on the af website about a chap who had this procedure, theres an appendage in the left atria, like a small flap that accumulates blood when in prolonged periods of af. The chap in question flew to the US and as part of a procedure they removed it. Have a read, its in the af stories bit

[seasider18 in reply to jimmysouthgates]

Some cardiac surgeons remove the appendage during heart surgery. It would seem a good idea if they all did. When I mentioned my interest in the Watchman device to a cardiologist at my local hospital he checked my operation notes to see if it had been done. Sadly no.

[AnticoagulateNow]

Yes I heard about this two or three years ago - left atrial appendage occlusion to give the procedure its proper title. There is a page on the AFA website about it, including some case studies. In the UK it is not widely performed and then only on those at higher than usual risk of stroke who cannot take warfarin. I guess, with the advent of NOACs, those who cannot take warfarin now have other options and perhaps the procedure is becoming even less common - I don't know.

I did read a statistic once which said that 95% of all AF related clots originate in the left atrial appendage. This led me to wonder why this is not offered to most of us. The answer it seems is that it is a risky op, more risky than most. Furthermore according to my EP the occluded 'pouch' becomes a potential store cupboard for clots and should the occlusion break down, which they can do, these would be released into the bloodstream with potentially devastating results. Hence the procedure is usually only for those for whom there's nothing else to lessen a higher than usual stroke risk. It's more available in the US but, without wishing to spread cynicism, there's probably a simple reason for that - $$$$!

A shame really as it looked like this is a procedure that has a lot going for it. Perhaps in time, as techniques improve, it will become more commonplace.

[RobertELee]

Yes I too heard about this some time ago and received a similar story about its risks from my cardiologist at the time.

I haven't asked the question of anyone but have since wondered why the appendage can't be cut off rather than blocked off (occluded). I'm sure there's a good reason but like our left-over tails, it doesn't seem to have particular function - other than clot formation!

[Susiebelle in reply to RobertELee]

I have been thinking the same

[MarkS]

The part you talk about is the left atrial appendage (LAA). It is where most strokes are supposed to originate. It can be removed, tied off or a filter put in to remove any clots.

However there is a lot of discussion about what the LAA does. It now appears to be very useful at regulating blood pressure. So rather like the appendix, which was originally considered redundant and is now considered to be anything but redundant, it does perform a very useful function. It also regulates thirst and its removal reduces cardiac output.

Keeping the LAA and applying a filter has shown mixed results.

So, for now at least, a plug is not quite as much of a miracle as might be made out (as so often happens with media "miracle" cures). By far the best bet is to take anti-coags and only consider doing something to the LAA if for any reason you can't take them.

[BobD Volunteer in reply to MarkS]

Mark as usual you have put forward a good and balanced argument. Yes the device has been around for quite a long time but it is only in the last year or so that I began hearing that the LAA was actually a useful part of our bodies. Always good NOT to be at the coal face of development.

[Susiebelle in reply to MarkS]

A good balanced comment - thank you

[PeterWh]

The procedure has been around for quite a few years. There are about 12 hospitals in the UK who have done it and are part of the studies / assessment programme. There are some good explanations and videos on some of the consultant's private websites.

[seasider18]

Getting it on the NHS is the problem. Privately the Watchman Device costs about £12K at the few private hospitals doing it.

bostonscientific.com/en-EU/...

There is also the Amplatzer Plug that has caused concern as recent reports say that they can clog up.

[Rellim296 in reply to seasider18]

Yes, I left Patients' Day last year all fired up on the idea of LAAO and made a private appointment with my EP to discuss it. At the time I saw it as a way out of struggling with Warfarin without moving to a NOAC, the thought of which I found scary. He rather dismissed my idea. He didn't say it would be a sledgehammer to crack a nut, but It is not something that he does and he thought it would not be available to me on the NHS. I've not pursued it. I've switched to Rivaroxaban, find the lack of antidote not the least bit worrying and am very happy.

[Jackieboy55]

Thank you all for your replies, I had not heard of this until Friday. The lady they were interviewing, who had undergone the procedure, for some reason could not take any anticoagulant , so I suppose for her it it was very useful. I'm not sure that I would fancy it though , it does look pretty invasive.

[seasider18]

It is invasive and the Harley Street Clinic surgeon who does it lists the things that can go wrong on his web site but no more than any other cardiac procedure.

dailymail.co.uk/health/arti...

[Hidden]

It's a shame they can't just do a simple procedure to see if you have a pool of blood there instead of guessing.

[dave205]

60% relative risk reduction in cardiovascular death in the WATCHMAN group over Warfarin

Wachman results:

Cardiovascular Mortality: the WATCHMAN group rates were lower versus Control: 1.0 per 100 patient-years for WATCHMAN and 2.4 per 100 patient-years for Control, demonstrating a 60% relative risk reduction in cardiovascular death in the WATCHMAN group (HR= 0.40, p=0.0045).

bostonscientific.com/en-US/...

[MarkS in reply to dave205]

That note was from Boston Scientific, the makers of Watchman, so it puts the gloss on it! Here are a couple of papers with a more balanced approach:

clotcare.com/watchman_devic...

medpagetoday.com/Cardiology...

The issues particularly concern the comparison to warfarin users who were only in range 55% of the time, which is very low. Also the users of Watchman had to use aspirin permanently which actually produces more brain bleeds than well controlled warfarin.

The cost of a Watchman at £12,000 should be compared with the £299 cost of a Coaguchek monitor which would dramatically improve time in therapeutic range and consequently reduce strokes and bleeds.

[Susiebelle]

The procedure is called Left Appendage Occlusion