WHY CLOSE THE LAA?
ATRIAL FIBRILLATION AND LAA CLOSURE
In atrial fibrillation (Afib), the heart beats erratically, which results in it being unable to effectively circulate blood out of the heart and through the body. This leads to blood collecting, or pooling, in the heart where clots can form. If a clot travels to the brain, a stroke can occur.
When blood collects in the heart, the place where it tends to pool is in the left atrial appendage (LAA).1 The LAA is a small sac found at the top of the heart’s upper left chamber (the left atria). If your doctor believes you are at risk for a stroke because of blood clots in your LAA, then you may be treated with blood-thinner medications (anticoagulants) and other medications that help regulate your heartbeat. If these medications are ineffective or if you cannot tolerate them, your doctor may recommend an LAA closure procedure.
The LAA is also a known source of electrical activity that can contribute to Afib. There is evidence that LAA closure with the LARIAT device may benefit outcomes in the treatment of persistent and longstanding persistent Afib and restoring the patient’s normal heart rhythm by electrically isolating the area where the LAA is located, when the medications to regulate your heartbeat have not been effective.
HOW DOES LAA CLOSURE WITH THE LARIAT WORK?
The LARIAT procedure involves guiding small catheters to deliver a pre-tied suture loop to the base of the LAA. The LARIAT device will be closed and the suture will be released and tightened, which leads to immediate and complete closure of the LAA. Unlike other potential options, there is no implant or foreign body left inside of the heart. Over time, the LAA will shrink and disappear and will no longer be a source of blood clots.
PREVENTION AND TREATMENTS
WILL LAA CLOSURE CURE MY ATRIAL FIBRILLATION?
Until the LARIAT procedure, there has not been a non-surgical method of closing the LAA to isolate the electrical activity that can contribute to AF. When combined with pulmonary vein isolation (PVI), studies have shown an improvement in freedom from AF versus performing PVI only.2
ATRIAL FIBRILLATION, LAA CLOSURE, AND STROKE
If your doctor believes you are at risk for a stroke because of blood clots in your LAA, then you may be treated with blood-thinner medications (anticoagulants) and other medications that help regulate your heartbeat. If these medications are ineffective or if you cannot tolerate them, your doctor may recommend an LAA closure procedure.
LAA closure is an option for patients who may be unable to take blood-thinning medications to prevent blood clots caused by atrial fibrillation. The blood thinner may have caused new bleeding. Or, with warfarin (Coumadin), the dosage may be difficult to regulate. Despite being on blood-thinner medications, some people still have problems with blood clots. Your doctor may recommend LAA closure as a potential option.
HOW DOES LAA CLOSURE REDUCE THE RISK OF STROKE?
By reducing the risk of blood clots, LAA closure can prevent stroke, or at least reduce the risk of stroke.3 The procedure works by closing off the left atrial appendage (the sac where blood clots form in the heart). The type of stroke brought about by a blood clot (including a blood clot caused by Afib) is known as an ischemic stroke. Ischemic strokes account for nearly 90 percent of all strokes.
OTHER METHODS OF PREVENTION AND TREATMENTS
The goals of treating Afib are: to restore your heart rhythm to normal; to maintain a normal heart rhythm and prevent recurrence of the irregular rhythm; to protect against blood clots that lead to stroke. Three options are typically considered in the treatment of Afib.
Antiarrhythmic drugs can help control irregular heart rhythm, and anticoagulant drugs can help patients with Afib avoid blood clots and stroke. For some patients, drugs alone are a sufficient treatment.
Electrical cardioversion is a process in which the patient receives an electrical shock on the outside of the chest to “reset” the irregular heart rhythm back to normal.
Catheter ablation involves inserting a catheter (a narrow plastic tube) into a small incision at the patient’s thigh, neck or arm and gently guiding it to the heart. The catheter delivers radio waves, light waves, or intense cold to create scar tissue that helps stop erratic electrical signals originating in the pulmonary veins from traveling elsewhere in the heart.
These non-surgical procedures do not remove or close off the left atrial appendage (LAA) that may be contributing to the irregular heart rhythm of Afib.
The third option is a kind of surgery called a maze procedure. There are several variations of the maze procedure; all involve the surgeon closing or removing the LAA and using a series of small incisions—or the application of energy—to create carefully located scarring on the heart. The scars interfere with the transmission of electrical impulses.
One type of maze procedure has long been considered the “gold standard” for treating Afib, but all are complex open-chest surgeries.
1 Onalan O, Crystal E. Left atrial appendage exclusion for stroke prevention in patients with nonrheumatic atrial fibrillation. Stroke. 2007;38(suppl 2):624-630. doi:10.1161/01.STR.0000250166.06949.95.
2 Lakkireddy D, Mahankali AS, Kanmanthareddy A, et al. Left atrial appendage ligation and ablation for persistent atrial fibrillation (The LAALA-AF Registry). JACCCEP. 2015;1(3):153-160.
3 Sievert H, Rasekh A, Bartus K, et al. Left atrial appendage ligation in nonvalvular atrial fibrillation patients at high risk for embolic events with ineligibility for oral anticoagulation. JACCCEP. 2015:1(6):465-474.