Atrial fibrillation (AF) is the most common sustained arrhythmia in patients in the United States, and the incidence and prevalence are increasing. AF increases the risk of stroke by fivefold, and to offset the risk of stroke, patients are typically prescribed oral anticoagulation medication (OAC). However in 2015, Left Atrial Appendage Occlusive (LAAO) devices, a non-pharmacological stroke prevention solution, became available and made a significant impact in stroke reduction therapy.
In non-valvular atrial fibrillation (NVAF), > 90% of stroke-causing clots that arise from the left atrium are formed in the left atrial appendage (LAA). The LAAO implant is a minimally invasive, one-time procedure designed to reduce the risk of strokes originating in the LAA. The implant is permanent and patients are typically discharged the same day. The procedure is percutaneous and the implant is placed in the LAA via a sheath in the right femoral vein with the application of general anesthesia. Post implant care requires a 45-day dosing of OAC and a follow-up transesophageal echocardiogram (TEE). The patient can stop the OAC after confirmation of no leakage around the device after 45 day. Aspirin is often prescribed for daily use during this period.
Patient screening tools are available to guide physicians in determining which NVAF patients are potential candidates for the implant. Appropriate rationale to seek LAAO implant are as follows:
- Increased bleeding risks such as history of spontaneous bleeding – including GI bleeding
- High risk for falls
- Cognitive impairment
- Severe renal failure, thrombocytopenia, and cancer
- Poor patient compliance with OAC – such as cost or fear of bleeding
- Drug interactions – intolerance to OAC
- Lifestyle – occupation related high bleeding risk or heavy alcohol use
The Centers for Medicare and Medicaid Services recognizes LAAO implant as a viable option for stroke prevention. A Shared Decision-Making tool is required for completion prior to the implant procedure. This is an evidence-based cornerstone of LAAO which allows the patient, implanting physician, and referring physician to make treatment decisions together.
Since 2017, Parkridge has performed just shy of 500 LAAO implants with Dr. Christian Allan being the primary implanter and Dr. Matthew Wiisanen also performing this procedure. With Parkridge’s data submission to the ACC’s NCDR, we are able to measure and improve the quality of cardiovascular care. For LAAO implants, we are well under the national average for complication rates. Recently published data summarizing the past 2 years, shows a 0% complication rate at Parkridge.
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