The Mercy Angiography team, led by Dr Jim Stewart, have introduced a new service called Left Atrial Appendage (LAA) Closure. This technique is aimed at patients with Atrial Fibrillation (AF), who do not have artificial valves, as an alternative to long term treatment with the anticoagulant, warfarin.
AF may lead to development of a blood clot in the LAA and dislodgement of the clot can lead to stroke. Warfarin is effective at reducing the risk of stroke in this setting, but it is a difficult drug to use because of the need for regular blood tests and risk of bleeding complications.
What devices are available?
An alternative approach to reduce the risk of blood clot formation in the LAA is to remove the appendage from circulation by closing it off, using a form of "plug". Several different types of such a device are in development, but there is only one that has been tested in clinical trials against warfarin and is available for routine clinical use: the Watchman device.
Who is suitable for LAA closure?
This therapy could be an option for patients who have AF and other factors that increase the risk of stroke, particularly if they have difficulty managing warfarin therapy. Patients who have artificial heart valves or who are likely to need valves may not be suitable.
The LAA occluder is inserted through a tube positioned in the LAA from a puncture in a vein in the groin. The procedure is done under general anaesthesia with transoesophageal echocardiography to help select the correct size of the device and to help with device positioning.
Normally the patient will have a single overnight stay in CCU. Ideally, warfarin will be continued for another 6 weeks after the procedure until a follow-up echo shows satisfactory sealing of the LAA. The patient will then remain on aspirin alone.
What is the Science?
The Protect AF Study has shown the Watchman device to be safe and effective. Most patients (87%) were able to stop warfarin therapy 45 days after the procedure, without any increased risk of stroke.
Contact details for Auckland Heart Group
Address: 94 Mountain Rd, Epsom, Auckland
Phone: 09 632 1020
Facsimile: 09 623 2845 or 09 623 1030
Website: Auckland Heart Group
Contact details for Mercy Angiography
Address: 98 Mountain Rd, Epsom, Auckland.
Phone: 09 630 1961
Facsimile: 09 630 1962
Website: Mercy Angiography