AF Association
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Alternative to anticoagulants? "Left Atrial Appendage Occlusion"

birminghamheartrhythmgroup....

Anyone had this done or know much about i?

Reading this, I'd be interested. I'd have to pay for it I guess as I wouldn't qualify under NHS as I'm not desparate.

I take anticoagulants as the least worst option, but I'd rater not and this sounds very interesting to me.

Sorry if this has come up before.

Koll

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I liked the sound of this very much, but if you are just not too keen on anticoagulation, is it perhaps a sledgehammer to crack a nut? When I mentioned it to my EP, he dampened my enthusiasm and said he did not see it as a way forward for me. It would not have been offered to me on the NHS. If you are at risk and unable to have any anticoagulation, it is a possible way forward.

I heard it was going to be trialled in 10 centres in the UK three years ago, but enthusiasm seems to have waned.

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The AFA have been campaigning for it to be funded by the NHS for patients unsuitable for warfarin and NOACs.

heartrhythmalliance.org/aa/...

Patients with mechanical aortic valves can only take warfarin and there is a lot of debate as to those with tissue valves taking NOAC's. Cardiologists are willing to risk them although the makers say that they are contra indicated as they have not been fully tested. One trial on them was stopped due to poor results.

Many surgeons are routinely removing the LAA during heart surgery particularly when replacing the mitral valve.

Older AFA report

.

healthunlocked.com/afassoci...

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Koll as you guess this is not available on NHS in UK. There is also some reservation in some quarters (USA?) regarding the wisdom of this procedure from what I have read. I think you need to do a lot more reading before making any decisions.

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The procedure is approved by the FDA and other devices are coming on stream. The stock market sees huge future growth for the companies concerned.

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Koll, there is a report somewhere which came to the conclusion that the procedure perhaps did not prevent clots from forming in other areas of the heart and therefore was risky in stroke prevention.

Here’s one report, which might guide you:

circ.ahajournals.org/conten...

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The article you cite is 9 years old. There are more recent papers on the subject. I'd urge the OP to do more research.

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Thanks for pointing that out. I’m going to ask my EP next time I see him. That could be a year or more but I’m not in a rush.

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Yes, reading the detail, they say still the best thing is oral anticoagulation and this procedure is for people who can't tolerate the drugs and possibly other reasons.

I don't think that's me. I just don't like taking any drugs.

But let's hope they'll come up with something better in time, I'm sure they will eventually.

Koll

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I'm on the present waiting list for Watchman device to be fitted on the NHS due to another condition which prevents me from taking any kind of anticoagulant. I'm quite apprehensive as it still a relatively new procedure but due to see my consultant EP in 4wks so hopefully he can put my mind at rest and answer some of my concerns. The procedure was due to take place next week but I've put it off for another 3mths as feeling very anxious, I'll keep you posted on the outcome and any other information. I think I've googled too much and maybe worried myself unnessessarily!

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Angie,

I am wondering if you had thecWatchman put in? How are you these days?

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Hi, yes well I went in to have the Watchman but had an Amplatzer amulet device fitted instead as my LAA was too small for the Watchman so wouldn'thave been a good fit. I'mpleased to say that it seems to be all good at the moment and I'm due to see my EP in 2wks when hopefully he will take me off the aspirin too. Thank you for asking. 😀

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Wow!! That is fantastic success! Wow!

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Koll,

Here's an article written last summer by Dr John Mandrola, one of the top EPs in the US:

drjohnm.org/2017/06/new-dat...

I think the Watchman should only be used by those who cannot take any OAC's at all.

Mark

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excellent article! thanks for posting. this may explain why another poster's doctor advised against it.

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I think this procedure was the 'next great hope' to replace warfarin before the NOACs appeared, but now that we have NOACs I think it's regarded as an obsolete procedure.

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Both the Watchman device and the latest Amplatzer amulet that was trialled at ten UK hospitals and others worldwide last year are post NOAC.

I have posted several times on my April Amplatzer procedure at the Royal Sussex where they had already done over 110.

There is also the Lariat where they 'tie up' the LAA.

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I meant the procedure itself was developed when NOACs were well into the future. Watchman is just the latest variant to implement the technique. And I thought the Amplatzer was for fixing structural heart defects ?

But anyway, many have concerns over the whole technique as we don't really know what impact closing the LAA will have longer term. Fortunately most AF occurs later in life but with most people able to tolerate NOACs, I think I'd prefer heart surgeons to be spending their time performing ablations, bypasses and other necessary operations as the demand far exceeds supply.

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There are evidently several different Amplatzer devices used in different parts of the heart.

The present Amplatzer amulet used on the LAA is I believe the third generation one.

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The LAA is a rather strange organ as it varies in size and shape.

A transesophageal echocardiography (TEE) study in the link below found that 1.6% of patients treated with anticoagulation for 1 month had echocardiographic evidence of an LAA thrombus

imaging.onlinejacc.org/cont...

An interesting rather older 1999 BMJ article

heart.bmj.com/content/82/5/547

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Hello Koll,

I too did not like taking my Warfarin and those pesky INR visits. I did some research and weaned myself off of them and have been off of "approved" anti-coagulants since early 2015. What I use:

Natokinase - 2,000 FU per serving once per day. Occasionally I take 1 at night too if my AFIB kicks in more.

Sluggish blood flow also increases the risk of clot formation. But the nattokinase benefits in natto reinforces the actions of plasmin, your body's own enzyme that breaks down the clotting agent called fibrin, thereby preventing abnormal thickening of the blood. Read about it here:

globalhealingcenter.com/nat...

drsinatra.com/learn-about-n...

mercola.com/Downloads/bonus...

Aspirin warnings with Nattokinase and comments including excerpts from medcal studies. raysahelian.com/nattokinase...

Vitamin E - 400IU qty 2

Vitamin D3 5,000IU every other day.

Occasionally I also take (about 2 times a week) Krill oil 1500mg

i've felt pretty darn close to normal taking these items and if I take too much EG: 2 Nattokinase/day on a regular basis, then any cut I get takes noticeably longer to clot.

NOTE: I just saw my cardiologist In November. When I first was diagnosed with AFIB in fall of 2014, he wanted me to have either an ablation or cardioversion. I am sorta kinda an all natural kind of guy so have been working toward an all natural solutions. They take TIME to kick in and until you see the beneficial results. I rarely get shortness of breath and my heart rate went from peaks of 150-165 normal 90-105/ sleep 85 to now sleep 62-78, normal out and about 72-86, elevated with exertion 120. BP was often 150/95-100 Now 130/75 as measured at cardiologist office.

Cardiologist now says that the way I'm going, that he no longer thinks I need any procedures. He said that it looks like diet and exercise will do it for me. My method may not be for everyone, but I sure feel good and enjoy my life again.

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Hi

How are you? I am encouraged by your getting off of anti co’s. I love the natural approach. Did you have any co-mobilities? What was your chad-score?

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Hi Koll

Saw all the replies, and I don't think anyone pointed out that LAAO can be either internal (using a device such as Watchman) or External which involves tied off the Left Atrial Appendage from the outside of the heart. Obviously this is usually only done when carrying out other procdures such a heart surgery, due the complexity of opening the chest or going in from the side and deflating a lung first.

NICE certainly are not currently in favour unless oral anit-coagulants are contra indicated, but I also understand that the external tying off is not a regular feature of those having heart surgery such a by-pass etc, given that so many heart procedures can trigger AF later, I do wonder why this is not used more.

Of course as someone has pointed out, clots can form elsewhere in the atria, so the whole procedure is probably second best to anti-coagulation itself.

Be well

Ian

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Currently this procedure is only offered if you are unable to tolerate an oral anticoagulant. However at present it is not available on the NHS as it is one of the devices currently under review in the Commissioning through Evaluation however it is NICE and FDA approved

.

We will of course update you as soon as we receive more information. Arrhythmia Alliance, AF Association and our All Party Parliamentary Groups have been campaigning to make this available through the NHS as for some people this is their only hope to help prevent AF-related stroke

.

You can read our information sheet on the LAAO procedure by downloading it from our website at heartrhythmalliance.org/afa...

If you have ant further questions, please do not hesitate to contact us. 01789 867502 or info@afa.org.uk

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