left Appendage op

[mjm1971]

ok so. !please stay with me on the below .

Im 52 and I have lone AF , my mum had stroke caused by AF with only her age as any other factor .

I have had 2 ablations both failed and so I’m still in PAF

They now want to do a 3rd procedure called an Ethanol injection .

let’s say that procedure takes 3 hours and. Another overnight stay .

that will be a total of 14 hours in surgery and 3 nights in hospital I have had trying to stop the AF or as some like to say give me BQL .

a mini maize would have been the same cost to the NHS and they could have blocked my left appendage to stop me ever having a stroke caused by AF !

stroke is the killer not AF so why won’t they treat the left appendage in all of us and why not just do the mini maize .to start with ?

Nothing to do with wanting us to stay on meds I hope ??

Have I got all my research wrong ?

I’m now having to book a mini maize procedure in Tokyo under Dr OHTSUKA and no it doesn’t guarantee it will cure the AF but it does guarantee I won’t have a stroke ……

can anyone explain the logic of why we go through so many ablations and why they don’t just block the left appendage in us all and eliminate the biggest risk to us all THE STROKE ??

[Cat04]

I agree. I previously had an ablation (RF ganglionated plexus) in 2018. Last year I went into persistant AFib/atypical AFlutter. Earlier this year I needed open heart surgery for an aortic valve replacement and also had PVI ablation and LAA epicardial clip done at the same time. I feel very fortunate to have had all 3 done at once by the NHS.

[mjames1]

The cynical answer is because ep's don't do mini maze, so on the whole they don't recommend mini maze.

They also don't do a real LAA closure, so they also don't recommend that either -- although they have gotten into that game with the Watchman and Amulet device, but unlike Atriclip (often done with mini maze), Watchman and Amulet require daily aspirin for life as clots have a propensity to form on the device itself. Yes, can't make this stuff up

But in all fairness, mini maze is a much bigger procedure than catheter ablation. Requires a hospital stay and longer recovery time. I chose not to do it, because being in my 70's, I did not want to subject my body to all that trauma, without at least trying a less invasive catheter based procedure first. I am however toying with the idea of having Atriclip independent of the Mini Maze, but again, pretty invasive.

Good luck with Dr Ohtuska. As you probably know, one of our members here, Saul, has had a great result so far and has nothing but good words for the doctor.

Jim

[mav7 in reply to mjames1]

Good answer, Jim !

iirc you have a flutter vs AFib ?May I ask if the ablation was successful ? Or too early to determine ?

I recall you posting that some symptoms were said to be normal by the EP.

[mjames1 in reply to mav7]

Yes, Mini maze doesn't address flutter directly, so that would then require a separate catheter based procedure. I've had two ablations so far. One for aflutter and three weeks ago a Cryo PVI for afib. The flutter ablation may not have worked, but I'm hoping that the PVI may fix that. So far so good, but still on daily Flecainide, so too early to tell. Thanks for asking. Not sure what I posted before re "normal symptom"?

Jim

[mav7 in reply to mjames1]

Thanks for sharing !

I can't recall exactly but seems you mentioned shortly after the first ablation your Kardia had recorded some irregularity that the Dr said could be normal. It was uncertain at the time. I may have you confused with someone else, not sure.

[mjames1 in reply to mav7]

Yes, after the aflutter ablation I had a run of what looked like flutter on my Kardia and shared with doctor. My concern was that unlike with afib, there is no "blanking" with aflutter ablation. In other words, it either works from the get go or it doesn't, at least according to the ep's I've spoken to with no literature to the contrary.

What my ep said was that if indeed the ekg was typical (right sided) flutter, then the ablation didn't work. However, he did leave the door open that the ekg showed either atypical (left sided) flutter, or perhaps it wasn't flutter after all.

For me, this will be all academic if it turns out after the ablation I will have no afib and no flutter. If the flutter does return, then less academic

Jim

[Poochmom in reply to mjames1]

just as a reference Jim, if a person has atypical flutter (left sided) the MiniMaze does address that. Typical flitter(right sided) MiniMaze does not address.

[mjames1 in reply to Poochmom]

I know atypical (left sided) flutter is sometimes addressed by ablating the pulmonary veins, either by catheter or mini maze, but wasn't aware that mini maze also addressed atypical flutter if it's coming elsewhere on the left wall. Does Wolf talk about this, because I know he works with an ep at the same hospital who is sometimes brought in for flutter issues.

Jim

[Poochmom in reply to mjames1]

Yes Jim, Dr Wolf does talk about this in some of his webinars on you tube. The atypical flutter is addressed by the actual MiniMaze and doesn’t require an EP. He does work with an EP, Dr Fahed in Houston who handles the typical flutter that sometimes rears it’s ugly head after the MiniMaze, especially with people who have had ablations as I understand flutter can be a side effect of ablation.

[Pjt55 in reply to mjames1]

I see your statement that the Watchman requires aspirin for life? I had the watchman implanted 3 years ago amd I only took aspirin for 3 months after while the healing took place. I do not take any aspirin or anticoagulant at all anymore. One big reason I had the watchman was because I needed to be off of all aspirin and anticoagulant meds.

[mjames1 in reply to Pjt55]

I can't talk to your situation, but I have always seen variations of the post Watchman anticoagulant protocol below. Aspirin for life has always been the constant. The concern is clot formation on the Watchman Device itself.

"The best anticoagulant management following implantation of the WATCHMAN device is still unknown. In the first 45 days, warfarin and aspirin are the most often utilized medications, followed by six months of DAPT from the day of the procedure and then lifelong aspirin. "

ncbi.nlm.nih.gov/pmc/articl....

[SeanJax]

there is a combined technique mini maze and ablation which has 96% success over 5 years. It is performed in US but not in a lot of centers. I try to reiterate that after ablation and or mini maze control and manage of risks factors for Afib still remain a huge factor in the long term success of the technique. There is no such a thing one and things are done. Always good life style managements

[BobD Volunteer]

As I recently replied to another similiar post, some doctors believe that the LAA is an important part of our hearts and has an important part to play. maybe in releation to BP control.

It must also be understood that whilst most clots do form in the LAA they can form in other parts of the heart too so nothing is fool proof.

[mjm1971 in reply to BobD]

hi Bob

Well clearly there are top experts in AF that don’t agree with your statement as Dr OHTSUKA ( who has performed 2000 mini maize procedures ) is guaranteeing 100% that it will stop the risk of stroke from my AF and I will never need anticoagulants again for AF .

So where do your stats/facts come from re the clots as I would like to call out Dr OHTSUKA if what he’s selling me is not true etc . I’m not paying circa £18k for a promise that isn’t 100% accurate .

Thanks

Matt

[Poochmom in reply to BobD]

Bob, from my research, the LAA does play a part in blood pressure but what I’ve seen in people with high blood pressure, after the LAA is clipped many have lower blood pressure and can get off blood pressure meds. Additionally, AFib can generate from the LAA in some people and the clipping removes that also.

I do appreciate your posts as they contain a lot of informative information. I just wanted to share what I’ve read concerning this by doctors in the US. Definitely could be different opinions across the pond.

[BobD Volunteer in reply to Poochmom]

Appreciated. Thanks. As I keep saying, its all very new science and we are constantly learning.

[Cookie24 in reply to Poochmom]

Your comment is very interesting to me. Can you send a link to me with the source of your comments on the reduction of blood pressure and afib after the clipping of the LAA. My blood pressure has been lower. My LAA was isolated at my last ablation and EP recommended Watchman. I am in USA

[Poochmom in reply to Cookie24]

I don’t have a link to a specific study or publication regarding it. I am going on others testimonials of what their experience is after clipping the LAA. Dr. Wolf, however, does talk about this in some of his you tube webinars. I take what he says on things very seriously as he is an expert in lone AFib and he helped develop the atriclip

[nettecologne in reply to Poochmom]

What does he say about this?

[Poochmom in reply to nettecologne]

He says that. CLipping the LAA reduces stroke risk by 97% so no more blood thinners for AFib even if it were to come back after WMM,that 20% of people have AFib that originates in the LAA so it takes care of that and that the LAA is a factor in blood pressure and that many people have been able to go off or reduce blood pressure meds.

[BobD Volunteer]

There will always be doctors who have differeing opinions is all I am saying. I wish you well.

[mjm1971 in reply to BobD]

hi Bob

I appreciate that but if there is evidence that my Dr in Tokyo is not telling the truth ( as your statement would suggest) then I would like to know the evidence where the statement came from please .

Or if it’s just opinion and not fact then I will stick with a Dr who is guaranteeing rather than speculating etc .

Thanks

Matt

[mav7 in reply to mjm1971]

Slow your roll !

The left atrial appendage (LAA), described as the “most lethal human attachment,” is responsible for >90% of embolic strokes

While there’s no surefire way to prevent strokes, removing or blocking your left atrial appendage reduces your risk significantly. This is because 90% of strokes that start in an upper heart chamber start in your LAA

ahajournals.org/doi/10.1161...

my.clevelandclinic.org/heal....

Be very, very leery of any doctor who guarantees 100% success with any procedure.

[Poochmom in reply to mav7]

absolutely agree with your last statement, no

Procedure is 100%!

[Singwell in reply to mjm1971]

I suspect it's not about truth but about evidence. A practitioner may have had 100% success so far in all patients treated with minimaze procedure in relation to strokes. Maybe not all doing that procedure can report that. That's one thing, the other is body of evidence with bigger cohorts. Medical practice tends to err on the side of caution in relation to outcomes. Sometimes this is to our disadvantage as well as advantage. I'd certainly consider the minimaze in future if I could afford it and if I felt I needed it. Then it'd be a judgement call with the anticoagulants as I tend toreard high BP.

[Singwell]

Currently the left atrial appendage occlusion op is only available in the UK for those who can't take anticoagulants. Its a terrible shame as it's relatively easy to do - similar to an ablation. Hopefully it will come in time. And yes, my understanding is that it's the stroke that's the main killer in instances of AF untreated. But I think it also depends on other factors such as BP cholesterol, blood sugar issues etc.

[MummyLuv]

personally I think the NICE guidelines need updated. They were written when mini maze surgery was new and the risks from surgery were still higher than catheter ablation, this is no longer the case. There are several international studies, no UK one yet. Mr Hunter is hoping to publish one soon, that should help update.

I don’t see mini maze or left appendage clip/staple becoming a first line treatment for everyone though, there is a shortage of supply of those with the skills to do it and as has been said EPs are the dominant force in this field of medicine and they don’t do this. So where they will be persuaded to refer people to their cardiothorasic colleagues is where their procedure is less effective ie those with failed catheter ablations or persistent afib.

There are more examples of convergent hybrids being done in the UK, where EP and surgeon work together and it’s a slightly less complex piece of surgery, LAA is clipped as part of that procedure. I think this will be the direction of travel.

The atriclip does not prevent 100% of strokes as not all strokes come from the LAA (90% do). It has a higher success rate than the watchman as clots can gather on the watchman device which is why it was redesigned, I don’t know the success rate of the newest watchman device, it’ll be interesting to see, if high we may see this becoming more common practice as you say to prevent strokes, the main risk from afib, Surgeons can claim they have 100% record personally ie no strokes to date, but I’d have my eyes open that it’s not guaranteed.

I think it’s amazing you are heading out to Japan, I wish the UK procedure was cheaper (or better still widely on the NHS) so people don’t have to 🥲. You will be in the hands of an excellent surgeon, wishing you well and look forward to hearing your journey.

[Robfromwales]

I just had a LAA clipped as part of a much bigger operation on an ascending aortic aneurysm and was told it helps prevents about 60 per cent of strokes ( I presumed from AF) .

[Cookie24]

Can you send links to information about Ethanol injection? Why is this recommended for you?

[willywombat44]

I had a Watchman device fitted in February 2022 as part of the Champion AF Trial in the UK. One hour under general anaesthetic, three hours recovery and home.In reply to comments above it has made no difference to either my labile hypertension or Atrial Fibrillation.

[Busby2023]

I agree about shutting off that area in all of us. I said something to my cardiology nurse, thought it was called Wolfe mini maize, but she said, no, it’s the watchman’s, but only for people intolerant to blood thinners. ☹️

[Spangle14]

Well said, I am very sceptical about the constant attempts at ablation.