For some patients with atrial fibrillation (AFib), a single device — which can be as small as a quarter — may make a big difference in protecting them from blood clots and stroke. This left atrial appendage closure device gives doctors a minimally invasive treatment option for people who have AFib and can’t take potent blood thinners for long periods.
This procedure is now available at Suburban Hospital, part of Johns Hopkins Medicine. Johns Hopkins specialists perform complex cardiac services at Suburban Hospital, including this left atrial appendage procedure.
Individuals with AFib can be at a greater risk of forming blood clots in the heart because blood can pool and stagnate when the heart pumps irregularly. If a blood clot breaks loose from the heart or arteries, it could travel through the blood vessels into the brain and cause a stroke. That’s why most people with AFib take powerful prescription blood thinners to prevent clots.
Studies have shown that most AFib-related clots form in a single location — a small pouch in the muscle wall of the heart’s uppermost left-sided filling chamber, the left atrium. This pouch is known as the left atrial appendage. While the role it plays in the heart’s functioning isn’t well understood, one thing is clear — this appendage is a major source of blood clots in people with AFib.
Because open-heart surgery is invasive, it is generally not performed only to prevent blood clots. The preferred treatment strategy to prevent these clots is medication with potent blood thinners like apixaban, warfarin or coumadin.
“Not everyone can take these blood-thinning medicines in the long term,” says Rani Hasan, M.D., M.H.S., regional medical director of the Structural Heart Disease Program at Suburban Hospital.
“We still need a way to reduce the threat of blood clots and stroke for these individuals. That’s where this device comes in — it gives us a way to lower clot and stroke risks without open-heart surgery or long-term treatment with strong blood thinners.”
The device is directly placed in the left atrial appendage, using a catheter inserted through the groin into the femoral vein and threaded up to the heart. When it reaches the left atrial appendage, the device is placed inside the opening, where it expands into place and closes off the appendage from blood that might otherwise pool in it and form dangerous clots.
Interventional cardiology and cardiac electrophysiology specialists at the Johns Hopkins Hospital, including Hasan, have offered this treatment option for the last several years. It is available in the Washington, D.C., area at Suburban Hospital’s Structural Heart Program.
It’s important to note that this device doesn’t completely replace blood-thinning medicines. Standard blood thinners are still absolutely necessary in the weeks and months after the device is implanted, stresses Hasan. However, over time, some people who have the device implanted are able to taper their dosage of blood thinners and switch to less-potent medicines, like aspirin.
Hasan also cautions that this is not an alternative treatment for everyone with AFib. “For younger patients and really, for most people, blood-thinning medicines will continue to be the first-line strategy. But it is definitely worth it for people to be aware of all the treatment options available to help prevent clots.”
He advises everyone to “be prepared to discuss all these treatment options with your care team so you can work together to find the one that will work best for you.”
