Left Atrial Appendage Clip

[OLdCroc]

Hi. I have been lurking on here for a while and not seen any reference to the above. I had SVT and AF and the Ep did the ablation for SVT which has, so far, been successful. However I still have the odd episode of AF. I am reluctant to take anti-coags as I also suffer from AMD for which I get monthly eye injections to prevent or stop leakage of blood vessels. To cut a long story short it was decided to fit an Atrial Clip to the atrial appendage where a high percentage of clots form in the heart. The clip prevents blood entering the appendage therefore preventing clots from forming. This operation was done by a mini thorochotomy (?) ie a cut between ribs in my back and instruments inserted through there to do the necessary. I was supposed to have a cryo ablation done at the same timethrough the same incision but due to the drs' strikes this was not done.

Has anyone else on here had anyghing similar done (ie the atrial clip via thoracotomy) and if so how has the recovery been?

[PeterWh]

Search for watchman as that is the name of one of the manufacturers. I forget the name of the other manufacturer.

[BobD Volunteer]

I think the thorachotomy procedure is called Lariate and is relatively new in UK. I was only aware of one doctor Jonathan Hyde I think near Southampton who was doing this procedure which he learned in USA.

Watchman is inserted via catheter and is basically a tea strainer which fits over the entrance to the LAA.

Bob

[OLdCroc in reply to BobD]

Thanks Peter and Bob. The clip i had inserted was not the tea strainer type - it was a clip which actually prevents the blood entering the appendage. I am just waiting for the surgeon to let me know the manufacturer and make.

The op was done by Mr Lall in Barts. I was referred to him by Prof Schilling. I will post the detail when I get it. I thik it is useful for others to know that there are alternatives to anti-coag if required.

[PeterWh in reply to OLdCroc]

Yes it is useful and I misread what you said.

Yes I had read about the clip though note sure where. It may have been the Barts site or Professor Schilling and team's site at the London AF Centre or just a general publication or possibly the AFA's main site. I am sure that it is under trial at the moment at a handful of centres.

[seasider18 in reply to BobD]

Jonathon Hyde is in Brighton. The procedure comes up if you Google him. NICE do not recommend that procedure. I'm sure that I posted a link to it previously but can't find it at the moment.

[Rellim296 in reply to seasider18]

I think it might be better to say that NICE do not recommend at the moment. About two years ago there was going to be a study of left atrial appendage occlusion at ten different places in the UK. I'm not sure exactly which technique was to be evaluated.

[PeterWh in reply to seasider18]

Relim has a very good point.

With all new procedures they have to be evaluated and assessed even if they have been successfully deployed elsewhere in the world. NICE will commission studies (and in this case apparently evaluation) but approval can take years!!!

On a general note even if the results come up good there is no guarantee that NICE will endorse (just look at recent press coverage on some cancer drugs).

[BobD Volunteer in reply to PeterWh]

We had a discussion some time ago about LAAO and there are some who think that the LAA DOES have a useful purpose and that removing or isolating it may be detrimental long term.,That really is the problem with AF treatment. All so new and little long term data.

[BobD Volunteer]

I think the Lariate may actually cut off the LAA with a heat knife wrapped around it. Not sure but there are many new procedures for such where other medical conditions make anticoagulation impossible.

[seasider18 in reply to BobD]

That is how they do it. It is business with vast potential for profit from a reliable method of blocking or removing the LAA. How can such a simple filter cost so much?

If only surgeons would chop it off during heart surgery. I'm told that some now do.

[Poochmom in reply to seasider18]

Dr Ohtsuka in Tokyo Japan does remove the LAA when he performs the Wolf MiniMaze.

[Ianc2]

I had this done as part of a valve repair procedure on 22 may 2014 at The Royal Brompton In London and I was shown an x-ray showing the clip lurking in my chest,( along with a mini maze procedure to attempt to deal with AFIB). The clip looks like a mini clothes peg.

I did ask how do you get it out again . They smiled nicely and said "We don't"

[ling]

Just watched a health programme about AF and learnt about this marvellous option in place of anti coagulants - the left atrial appendage closure device. Apparently it is as, if not more, effective than anti coagulants, minus the horrible side effects.

[Poochmom in reply to ling]

the atriclip reduces stroke risk from AFib by 97% where anti coagulants reduce stroke risk by 60%. Big difference.

However, when the LAA closure is performed it must be tested to make sure the entire LAA is in the clip and no piece is outside the clip my doctor did a TEE while I was in the OR to test and make sure it was 100% closed