LAA Exclusion increases AF and gives no stroke benefit

Previously, it was considered that the risk of stroke could be reduced by removing or blocking off the Left Atrial Appendage (LAA). This new study indicates that this can lead to 4 times the risk of AF with no reduction in the number of strokes:

medscape.com/viewarticle/87...

So it would appear unsafe to stop anti-coags after LAA removal or blocking. At the very least a lot more research is needed into this.

15 Replies

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  • And some experts now think that the LAA does have a purpose. All comes back to this being new science.

  • Given my personal circumstances this article is very interesting. Twelve months ago I had the LAA clipped as part of a transthoracic modified MAZE procedure to control my AF. Good news is that I have been free from AF since then. The cardiac surgeon and EP cardiologist are both comfortable with me discontinuing Eliquis on the following basis. 1, AF is controlled (not present), and 2. LAA is gone (clipped).

    Their only concern is that I have already had 2 strokes (pre MAZE procedure). It has always been assumed that these were due to AF induced thrombi, BUT this can't be proven. So, as a final part of the puzzle I am having a cardiac MRI in the next few days. I have some LV enlargement, BUT this may well be associated with long term endurance training. The MRI is looking for cardiac muscle scarring. If present, it will indicate some intrinsic heart pathology and I will need to stay on anticoagulants. if there is no evidence of myocardial scarring then cardiac muscle pathology can be ruled out, the medicos are happy for me to go off anticooagulants. In the end its all a matter of risk management and lifestyle.

    The article provided gives me something else to think about.

  • robboian

    I have had 2 MRI scans recently, although not for my heart. My friend did have one on her heart and it took ages.

    My best advice is to ensure that your bladder is empty. They give you headphones but I found that foam ear plugs were better ( these were given to me for the 2nd scan)

  • Thanks for this v. helpful advice - I'm awaiting an MRI, (brain, to investigate my balance problems), although I expect it may be quite a while before I get an appointment.

    Pat.

  • PatAF

    Pat, one of my scans was for head and spine. They fitted me with a helmet, rather like a motor cyclist's helmet. It meant that I could not see the top of the scanner as happened when I had the first ( shoulder ) scan. That felt as if I was being fed through a plastic igloo with the top 3" away from my face.

    MRI scanners CLANK so ear defenders are necessary. You do have to lie still for a long time, hence my bladder warning. There is nothing painful though.

    Wear loose clothes with nothing metallic.

  • Sounds scary! I think my biggest worry is feeling claustrophobic, but as long as I can see out of the end of the scanner I hope I can avoid it. Thanks again!

    Pat.

  • I've had three MRI scans, kidneys, head and a three part spine and pelvic one. I have had foam earplugs, ear defenders and headphones with music and none kept the sound out for me.

    I was offered an eye mask each time but felt that would make me feel even more isolated.

  • The amplatzer device has been well studied as the original version has been around for over 15 years.

    fda.gov/ohrms/dockets/ac/01...

    NICE seem not to like the LAA being clipped. The EP who fitted my pacemaker last year checked my operation notes to see if it had been as he said that some surgeons do it as a matter of course but added that not all mention it! .

    I did not have AF prior to my aortic valve replacement and was surprised to be told that it happens to over 33% of patients and only a small % get over it during initial recovery time.

    I had a cardioversion that did not work a few days later.

  • Isn't the amplatzer something quiete different and also placed differently? My husband had one and it was done to close a hole in the septum. But that would not insure against strokes through AF, would it? Please explain.

  • I have not heard of the device being used in the way I understand you mean.

    The Amplatzer while different from the snip does much the same thing. One removes the LAA the other uses a filter to block it off. They both take away the area where clots form.

  • Ok. Maybe there are two Amplatzer devices. The one I mean is used to stop a hole between the atria, the upper chambers. It does not block any part of the heart. It just closes a hole which some people have while with the majority this closes during the first year of life. You still have a normally functioning heart afterwards. So not like LAA.

  • Thank you for this information!!! it was suggested I do that to be able to come off anticoagulant.

  • I have been trying to get one for some time but it is hard to get from NHS. Privately I could get one for Christmas as when I was considering having my aortic valve done. Then the surgeon then offered to get his team in on Boxing Day.

  • Would you still want to after the study above??

  • Yes. As with the watchman device there are a lot of contradictory papers around.

    At the moment I'm going to speak to my GP on Friday about any progress he may have made on NHS possibilities before answering this E-Mail message from EP who has finished the trial I did not get a place on.

    " I can see you in a private clinic to discuss if you would like"

    The problem with someone doing it privately is if any complications you have an unexpected cost. The one who offered to do my heart valve four years ago would have done it in the private wing of an NHS hospital. He said with anything like that or if I needed a pacemaker they would wheel me down the corridor to an NHS theatre. Southampton and other hospitals had warned of additional costs if a pacemaker was needed.

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