Atrial clip

[G0dfather]

Anyone had an atrial clip fitted or know anything about them. I have recently had open heart surgery for leaky valve and surgeon's assistant told me afterwards we have also done an atrial clip as you have had AF in the past. From what I can see on the Internet it prevents you ever having a stroke from AF as 90% of clots from AF generate from the left atrial appendage?

[BobD Volunteer]

I would not quote numbers but yes clamping off the left atrial appendage to reduce stroke risk or fitting a filter type device (watchman) is common in some quarters. It can divide opinions though as there are some cardiologists who consider the LAA to have an important part in cardiac life and best left alone unless there are strong reasons why anticoagulation is not possible,

[G0dfather in reply to BobD]

I have been on rivoroxaban 6 years or so and tolerate it well so there was no problem with anticoagulants. I am somewhat concerned this was not discussed beforehand.

[BobD Volunteer in reply to G0dfather]

If you were litigious I'm sure you would have seen a lawyer by now.

Sometimes people take decisions with the best of intentions. When you sign the consent form there are often catch-all phrases which allow for extra work or procedures where the attending doctor feels it important. Would you really want them to stop operating, wake you up and ask if they could do the tricuspid repair and wait whilst you signed for it?

When I had my prostate removed they found that the cancer had already spread to some other bits and bobs so took those out at the same time. Thankfully as eleven years down the line I'm still here.

[G0dfather in reply to BobD]

To be honest I'm just reviewing what the procedure involved so I haven't seen or spoken to anyone yet. I didn't review the paperwork earlier as I was in hospital 17 days after the Op.

[Hidden]

Hi andrewfitz. Nice of them to tell you afterwards! You can google LAA clips and find a lot of information about pros and cons, different types, and youtube videos of the clip installation if you want to find out more and you're not squeamish. I had an atriclip put in in September and I was keen to have one.I was expecting it to be offered so had done some research and agreed with the surgeon when he proposed it. He said he thought the appendage could be a source of my AF, and I would be able to come off apixaban afterwards. The doctor I saw after the op thought I should stay on the meds though, because of my other heart issues, so it would be as well to talk this through with your consultant = it may be fine for you. I hope your valve is mended!

[CDreamer]

They did that without your your prior knowledge or permission? How long ago were you diagnosed and what is your CHADS score?

[G0dfather in reply to CDreamer]

Yes I went in for a mitral valve repair. I found out afterwards they did the mitral repair tricuspid valve repair and the atriclip. Only the mitral was discussed or even mentioned before. Do you think I should get some answers and query this procedure. I have no idea what my Chad's score is I've had paroxysmal AF 10 years but 2 ablations seemed to have resolved it and I was sinus rhythm most of the last 4 years.

[CDreamer in reply to G0dfather]

Personally I would be asking a LOT of questions. I would want to know firstly why anticoagulation was not discussed and what your CHADS score indicated. Then why a surgical procedure was done without your knowledge. Did you read the declaration you must have signed prior to the procedure? Ask for a copy of that document and read it.

It may be that the surgeon doing the procedure acted in your best interest but it would worry me that there was no prior discussion as to the possibility. It’s not a procedure regularly performed in UK unless there is VERY good reason to do so.

I am assuming you are in the US?

[G0dfather in reply to CDreamer]

Hi I'm in the UK. I have a copy of the consent form in front of me. It only details mitral valve repair and possible Cox maze which was not done. There is a sentence that quotes" any extra procedures that may become necessary" during the procedure but I assume that would mean blood transfusion etc.

[CDreamer in reply to G0dfather]

I’m rather with Bob on this one, I’m not enthusiastic about atrial appendage clipping unless a last resort.

[Bambi65 in reply to CDreamer]

Clipping is the best possible option for anyone that can have it done!!!! Wish every surgeon would do this! Why would anyone object to this clipping? It removes the possibility of a stroke in that area!!!!

[CDreamer in reply to Bambi65]

And if that’s your choice fine - personally I would object - having read the studies.

But that’s NOT the point - it’s the fact it was done without knowledge or consent.

[Bambi65]

I have one and no longer take ANY anticoagulants because of it. All 3,000+ of us that have had the Wolf Mini Maze (not open chest surgery), by Dr. Wolf to stop afib, also had the LAA clipped as a standard procedure. My understanding is that with any open chest surgery the LAA is clipped, or stapled, and/or removed, since most of the stokes that are due to afib begin in the appendage. Congrats to you and your doctor for taking preventive steps to ensure you safety and longer quality of life.!

[credimus]

I had a leaky tricuspid valve repaired by open heart surgery six months ago. I was also informed by my respected surgeon - prior to surgery- that a clip would be attached to an appendage which would diminish the probability clots causing a stroke. I am 81 years old and have been suffering from A/F for 16 years.

[mav7 in reply to credimus]

You are an inspiration to many, credimus !

Can you share if your AF is persistent or paroxysmal and your medications ?

Thanks !

[credimus in reply to mav7]

Thanks mav7 - persistent AF - Warfarin for the first four years which was replaced with Rivaroxaban. Post surgery Apixaban twice daily.

[mav7 in reply to credimus]

Thanks for sharing.

I also have persistent AF, just wanted to get info.

[CDreamer in reply to credimus]

Do you know why the procedure was performed? You were previously on anticoagulants, so I wonder if the risk of bleeds exceeded the benefit of the anticoagulants. Least you were informed prior to the procedure.

[credimus in reply to CDreamer]

Hi CDreamer - Performed to prevent blood clots. As you are probably aware long term AF invariably results in an enlarged heart which causes the valves to malfunction.

[CDreamer in reply to credimus]

Yes but normally in UK only performed when oral anticoagulants are contraindicated or not tolerated.