Left Atrial Appendage (LAA) Closure for prophylactic A-fib treatment

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berkeman

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I just learned about this treatment option, and it seems very promising for patients (Pts) with nonvalvular atrial fibrillation (A-fib) heart dysrhythmia.

The biggest risk for Pts with A-fib is the formation of blood clots in the heart's quivering atria (the upper chambers of the heart), and those clots then traveling out into the body's bloodstream and causing blockages (especially those blockages leading to ischemic strokes in the brain). The traditional treatment (Tx) is to put the Pt on blood thinners like Coumadin or a daily baby aspirin, but this causes excessive bleeding issues that can be at least inconvenient and at most deadly.

But now it appears that there is a new class of Tx where the main part of the heart where these clots can form is actually closed or blocked off, which seems to drastically reduce the chances of blood clots forming in a heart that suffers from the A-fib dysrhythmia. I'd always assumed that the right atria was where most of the clots formed, but now I've learned that the majority form in the left atria, in a small side chamber portion called the Left Atrial Appendage. There is no known function for this side chamber of the heart, and unfortunately it mainly serves as a stagnant area of blood in the LA where clots can form in Pts with A-fib.

So there are now several ways to close or block off this LAA chamber, and that seems to drastically reduce the chances of A-fib Pts forming blood clots that can lead to ischemic stroke. Several of these Txs are mentioned in the linked article below. I've had many, many Pts over the years that I've assessed for various reasons who had A-fib (you can generally see this even without an EKG because of a particular irregular pattern in their pulse), and we usually have a conversation about talking with their doctor about their Tx options. From now on I'll be sure to mention the LAA Closure option that they should also discuss with their doc. Good stuff. :smile:

https://my.clevelandclinic.org/health/treatments/17167-left-atrial-appendage--closure


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https://www.emdocs.net/left-atrial-appendage-closure-procedure-basics-complications-and-management/
 
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Apparently it does have a function but in some types of atrial fibrillation it appears to be the source of clots, which form emboli. There appears to be a continuing debate as to whether the benefits outweigh the potential risks. In the UK it is only recommended for people who can't tolerate anticoagulants.

A couple of reviews.
https://www.ncbi.nlm.nih.gov/books/NBK553218/
https://heart.bmj.com/content/82/5/547
 
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