Only a third of patients who have atrial fibrillation (AF)—one of the most common types of irregular heartbeat—consider it to be a serious health problem, according to a 2009 survey conducted by the American Heart Association. However, because the disorder can cause blood to stagnate and clot, it significantly elevates the risk of stroke.
To combat this possibility, people with AF are often prescribed blood thinners, but misconceptions about the risks associated with the condition lead many people to eschew these lifesaving drugs. Others can’t take blood thinners at all due to recurrent bleeding, inherent problems with clotting or other risk factors, such as a history of falls.
There are, however, nonpharmacologic options that can also significantly reduce the risk of stroke for someone with AF. Decades ago, cardiac surgeons found that if they closed off the left atrial appendage (LAA)—a windsock-shaped outpouching in the muscle wall of the left atrium that collects blood and drains into the heart—by stapling, tying and other means, stroke risk shrank to baseline.
More recently, explains Hugh Calkins, director of Johns Hopkins’ Cardiac Arrhythmia Service, three cardiac implant devices have become available that offer an alternative means of reducing stroke risk in AF patients who aren’t good candidates for long-term anticoagulation therapy. To make the best recommendations for treatment with these devices, Johns Hopkins initiated the Left Atrial Appendage Occlusion Program to help evaluate which option is optimal for each patient. Although many institutions offer at least one of these options, he adds, Johns Hopkins is one of only a few that offer all three.
The first of these implantable devices, the WATCHMAN, is the only one that’s currently FDA-approved for LAA occlusion. Shaped like a small umbrella, it’s delivered via catheter to block the opening to the LAA. The second device, the AtriClip, is implanted using minimally invasive techniques. Surgeons place this bobby pin-shaped clip at the base of the LAA, preventing blood from entering. The third device, the LARIAT, is a catheter-implanted suture delivery loop that ties off the LAA.
Once one of these devices is in place, Calkins notes, no permanent use of blood thinners is necessary to treat the consequences of AF: “We’re proud to offer these very liberating options for our patients who aren’t good candidates for long-term anticoagulation.”