LAA Ablation and stroke risk

[seasider18]

healio.com/cardiology/arrhy...

[Hidden]

Did you have an LAA ablation with your Amplatzer?

[seasider18 in reply to Hidden]

No, I had previously turned down an RF Ablation, an AV node ablation and a cyro ablation. It seemed that they could not make up their minds what was best for me As they had fitted a single chamber pacemaker rather than the dual chamber pacemaker they said I needed I had little faith on their ablation decision. That's the trouble when you have seen three different EP's at the same hospital.

[rothwell]

Wish it was in English!!!!!

[CDreamer in reply to rothwell]

It is - what don’t you understand?

RF= Radio Frequency, LAA=Left Atrial Appendage, Amplatzer a device which is implanted, AV node=Atrial Ventrical node.

You will find a list of abbreviations on the ‘pinned posts’.

[rothwell in reply to CDreamer]

Never heard of Amplatz.......so basic translation......does having an ablation put someone more at risk of having a stroke...or does it depend on the particular type of ablation. The statistics were also confusing.

[CDreamer in reply to rothwell]

Amplatz is an implantable device used as a vascular plug. LAA is sometimes closed and this device used with people who are unable to tolerate anti-coagulants, instead of removing the LAA which used to happen occasionally. It’s very different to ablation but I can understand the confusion.

Ablation - the article talks about exactly where ablate takes place so what they are saying is that if they burn or ablate in or around the LAA there may be a higher risk of stroke as against those who have only pulmonary veins ablated. Least that’s my understanding.

The conclusion indicated more research is required.

[seasider18 in reply to CDreamer]

Quite a few surgeons remove the LAA during surgery particularly when replacing mitral valves as it is easier to get to then.

Speaking to the theatre 'sister' prior to having my Amplatzer amulet fitted he said that he was arranging for his fathers to be removed during his forthcoming bypass operation. My EP had checked my operation notes from my valve replacement to see if my surgeon had.

[Hidden]

So does being on anticoagulants reduce this risk? It's not really clear from the article.

[johnMiosh]

I am also a bit confused, I assume by LAA ablation, they mean electrical or RF isolation of the LAA. I did not think that this was a common procedure, and even in this study less than 40 people had it.

I do not think this applies to the amplatz or similar devices such as the atriclip (which I had) as these types of device remove or close off the LAA. Studies show that LAA closure reduces stroke incidence and most patients no longer require anticoagulents.

[seasider18 in reply to johnMiosh]

Did you get your articlip during heart surgery or at a later date ? The NICE reports I read prior to having my Amplatzer amulet fitted were not so keen on the articlip.

[MarkS]

This article refers to the LAA ablation - i.e. electrical isolation of the left atrial appendage which is only carried out where someone has permanent AF. The vast majority of people don't need that.

I assume that if the LAA has been ablated, then there is less circulation of the blood within it, hence the higher stroke risk? But the article doesn't make this clear. The adjusted rates are less for the partially ablated LAA compared with the fully ablated.

[seasider18 in reply to MarkS]

Part of the reason I posted the link was as some did not make complete sense to me and I was sure that others more knowledgeable would comment on it.

[dave205]

Thrombus on the Watchman LAA Occluder Tied to Higher Stroke Risk

Device-related thrombus mitigates the benefits of LAA closure relative to warfarin, but not relative to doing nothing at all, one expert says.

By Todd Neale May 14, 2018

BOSTON, MA—Patients who develop thrombus on the Watchman left atrial appendage (LAA) closure device (Boston Scientific) carry a greater risk of stroke or systemic embolism, and there are hints of a causal relationship, a new analysis shows.

Overall, 3.74% of patients in Watchman trials and registries had a device-related thrombus (DRT) detected, Vivek Reddy, MD (Icahn School of Medicine at Mount Sinai, New York, NY), reported at the Heart Rhythm Society 2018 Scientific Sessions here.

These patients had a more-than threefold increase in the risk of stroke or systemic embolism, as well as greater risks of major bleeding and hemorrhagic stroke. DRT was not associated with higher rates of cardiovascular or all-cause mortality.

How Does DRT Affect the Benefits of LAA Closure?

Serving as a discussant after Reddy’s presentation, David De Lurgio, MD (Emory University, Atlanta, GA), said, “DRT does continue to occur despite modifications of the device, despite increased training. It is something that is in the background and will be seen with the devices we know, including the Watchman device.

“What is a little alarming,” he continued, “is that the risk for DRT remains and extends well beyond the standard periods of anticoagulation, so there’s a big question about when are we out of the woods and is that something we can predict based on the patient profile or any other factors?”

De Lurgio pointed out that the factors associated with DRT in the current study parallel traditional stroke risk factors, “so that is maybe an insight into something we can do for these patients.”

He also alluded to the lower risk of intracranial hemorrhage that has been observed with the non-vitamin K antagonist oral anticoagulants (NOACs) when compared with warfarin to suggest another potential approach to improving outcomes in patients with DRT, who had higher risks of both ischemic and hemorrhagic stroke.

“The thought that there is an increased hemorrhagic stroke [risk], probably due to reinstitution of anticoagulation, does beg the question of whether there’s something we can do with different anticoagulants that are known to be associated with a lower intracranial hemorrhage should we see DRT,” De Lurgio said.

As for the impact of DRT, he said, “I do believe that DRT mitigates the benefits of left atrial appendage closure relative to warfarin . . . . However, it doesn’t mitigate the benefits of left atrial appendage closure with these devices relative to no therapy. And I think that’s a very important take-home message.”

tctmd.com/news/thrombus-wat...