If I was considering this, I would ask what shape my left atrial appendage is. If it was a high risk shape, I would consider it. See below. However, the LAA must do "something", so I wouldn't take it lightly. Also, I believe some of the ways they block off the LAA have come under critcism. I'll check it out.

"Compared with Chicken Wing, Cactus was 4.08 times (p = 0.046), Windsock was 4.5 times (p = 0.038), and Cauliflower was 8.0 times (p = 0.056) more likely to have had a stroke/TIA.

Conclusions Patients with Chicken Wing LAA morphology are less likely to have an embolic event even after controlling for comorbidities and CHADS2 score. If confirmed, these results could have a relevant impact on the anticoagulation management of patients with a low-intermediate risk for stroke/TIA."

http://content.onlinejacc.org/article.aspx?articleid=1273045


petey

I always like Chicken wings better than Cauliflower...but that is probably part of the reason for my current health problems!

I do remember there was some controversy over just blowing out the atrial appendage, but of course being old and senile, there is no way I could remember where I read this.

I am very happy to see on the other post (the poll about ablation) that so many people believe that we WILL find a cure for this in the future. It is nice to be optimistic...come on CURE!

Bill

Wow.

Fascinating that there are such bizarre structural variations on this area. I thought that when it came to internal organs, for the most part their construct was the same across the board. Colon, stomach etc.

One would think if it (the LAA) were there to begin with it had some task/value. But if they have had success blocking it or closing it up then the significance of it's role is in question.

All of this is wicked interesting and pretty complicated!! :-O

I wonder what the ratio/proportionate stats/numbers are with blood clots forming in the LAA and/compared to blood clots forming in other parts of the body - and causing strokes?

For afib it is like 95% plus form in this part of the heart. You could get a clot elsewhere for other reasons. 15% of all strokes are afib strokes spread among 2% of the population.

Re cauliflower versus chicken wings... I guess cactus is the least tasty.

It may be the LAA plugs that are risky. I can't remember either. I also read somewhere someone thought the LAA had something to do with pressure regulation in the heart.

another interesting article on the lariat
http://cardiology.ucsf.edu/care/patients/stories.html

opsyn

Dr Natale just performed his like 45th Lariat on my friend and prolific poster Shannon over on the other forum.
Dr Natale is fing out that ablating the LAA shuts down permanent or persistent afib for good in stubborn cases but that compromises the blood velocity out of the appendage. Any flow velocity below 20 would subject you to lifelong blood thinners but at least your afib is gone for good.

Similar to Natale, UCSF has also been a pioneer in the LARIAT where Dr Lee worked with SentreHeart, the developer of technology since 2007.

Since 2011, Dr. Badhwar and Dr. Lee have begun offering a two-part combined procedure for patients with persistent atrial fibrillation. They first perform the left atrial appendage closure using the LARIAT procedure. Because the appendage atrophies, it no longer emits rogue electrical signals that can contribute to atrial fibrillation. About a month later, Drs. Badhwar and Lee then perform catheter-based ablation of the left atrium, reducing or eliminating rogue signals originating in the pulmonary veins or atria
More than half of patients are staying in normal rhythm, which for this group would not be expected if they just had the ablation or the appendage closure.

I live in the Bay Area, and feel fortunate to have Natale and UCSF within a 30 minute commute. I have taken advantage of this and had multiple consultations with each. I generally find it takes about 3 months to get an appt as Natale is here one week per month and many UCSF ep's have limited patient hours because of their research, medical school teachings, etc.

opsyn

I am currently not a good candidate for ablation or Lariat since I am asymptomatic and not on OAC. However it is great to see such advancements as Lariat being made.As ep's get more experience I would think that Lariat and cathether ablation could be done at the same time rather than a month apart; it would be nice to see this expanded to include firm ablation and Lariat.

opsyn