Left Atrial Appendage Occlusion
This is a procedure for patients with atrial fibrillation who are unable to take warfarin.
Individuals who have a heart rhythm problem called atrial fibrillation may be at risk of stroke, unless they take the blood thinner warfarin. For those unable to take warfarin, rather than facing a high risk of stroke, we can block off the part of the heart where clots form (the left atrial appendage). This is like the appendix, in that it is a finger-like structure that protrudes from the let atrium, and does not appear to have any useful function.
This is a relatively new procedure, but it is an established technique with around 90 procedures being performed in the UK in 2011. It has been shown to be as good as warfarin at preventing stroke. The procedure requires a general anaesthetic in most cases, and is performed by a team of cardiologists. Small tubes are passed up from the vessels in the groin, to the heart. A needle is used to puncture between the two atriums (heart chambers) to gain access to the left atrium. The occlusion device is then implanted into the appendage and is checked with an ultrasound performed from the oesophagus (transoesophageal echo’). Once successfully implanted a layer of cells grows over the device, preventing any clot flying off to cause stroke. Aspirin and another aspirin-like drug, clopidogrel are used for a short period of time, while cells grow over the device. In the long term aspirin is all that is needed. The procedure can be combined with an atrial fibrillation ablation.
Suitability for this procedure can be assessed in the out-patient department and with a transoesophageal echocardiogram (a simple day case procedure).
Dr Turner and the Bristol team are the only cardiology department in the South West of England currently offering this treatment.