Nebraska Heart Institute (NHI) is one of the first sites in Nebraska and one of only a few in the nation to treat patients with a new catheter-based procedure that uses sutures to tie off the left atrial appendage (LAA), which is known to be a major source of blood clots that may lead to stroke in patients with atrial fibrillation (AFib).
AFib is the most common cardiac arrhythmia (abnormal heart rhythm). It can result in fainting, chest discomfort and shortness of breath, and is known to be associated with an increased risk of stroke. The LAA is a 1- to 2-inch blind sack that extends from one of the top chambers of the heart. In AFib, the LAA stops rhythmically contracting and the now non-flowing blood inside can turn to clot (a gelatin-like substance). If pieces of the clot break off, they can be pumped to the brain and cause blockage of blood vessels and stroke. Approximately 3 million adults in the United States have been diagnosed with AFib-related strokes accountable for about one-quarter of all strokes in the elderly.
The procedure involves the use of an instrument known as the LARIAT Suture Delivery Device. The LARIAT was designed as a method of closing the LAA without the need for major surgery. The procedure is performed in the cardiac catheterization lab under X-ray guidance and requires no incision. The LARIAT was cleared by the FDA for use in 2009 and is also approved in Europe.
“Nonsurgical options (performed percutaneously) generally mean less discomfort, and more rapid recovery,” said Hosakote Nagaraj, MD, interventional cardiologist with NHI. “That’s all very good for the patients, but in addition, it has the potential to decrease cost in the health-care system.”
Once a patient undergoes a successful procedure, it could lead to a permanent means of protecting patients who have AFib from stroke, especially those who are not able to take long-term anticoagulant (blood-thinning) medications such as Coumadin, Pradaza and Xarelto. Most suitable patients for LARIAT are those who are not able to take long-term blood-thinning medications because of bleeding problems or risk of falls.
During the procedure, a 3 mm puncture hole is made in the pericardium surrounding the patient’s heart. Guide wires fitted with strong magnets are threaded through the hole and used to establish a track to the LAA. The cardiologist then uses the LARIAT to follow the track and slip a lasso (a pre-tied suture loop) over the LAA, which can then be tightened under X-ray and ultrasound guidance, occluding the blind sac.
“Any time we can offer our patients an outpatient procedure instead of surgery, we are decreasing the risk of infection and complication,” commented NHI cardiologist Dr. Steven Martin. “Recovery times are generally faster and patients can get back to living their normal lives sooner.”
The procedure has been performed at Nebraska Heart Institute since March in patients who were considered high risk and who had no other options. The procedure involves a team approach at NHI including cardiologists, electrophysiologists and surgeons.
“Patients with AFib have limited options for long-term protection against stroke,” said Peter Gallagher, MD, electrophysiologist with NHI. “This is particularly true for patients who may not be able to tolerate or who have had complications taking many of the available blood-thinning drugs. The ability to percutaneously close a known source of blood clots in patients with AFib offers an attractive option to those patients who possibly need it the most.”
This procedure is part of Nebraska Heart’s Atrial Fibrillation Clinic which offers the most advanced, innovative treatment approaches through a specially trained, multidisciplinary team. Each person’s atrial fibrillation affects them differently, and our physicians collaborate to create a customized treatment plan designed specifically to treat each patient’s symptoms and risk factors. Through the use of advanced techniques and research, you can be assured that the physicians at Nebraska Heart’s a-fib program are leading experts in treating even the most complex cases.
To learn more about the LARIAT procedure, go to our LARIAT page.