Welcome to this, our Aug/Sept issue of the AFIB Report which is devoted to a special case study examining my own medical adventure of the last three months, beginning with a surprising, small stroke on May 10th that lead immediately to a whirlwind investigation ranging from St. David’s Medical Center in Austin Texas, followed by visits on two occasions to Scripps Green Hospital at Torrey Pines in La Jolla California in late June and late July. The big question to answer was: ‘how and why could I have had such an embolic event to begin with and what to do about it’?
The discovery at Scripps that my small stroke was, indeed, strongly connected with a late opening 4mm diameter leak in my previously ligated and initially well-sealed left atrial appendage (LAA) via an initially successful LARIAT procedure last August 2013, elevated this story in significance as the first, to my knowledge, published discussion anywhere of an actual CVA (cerebral vascular accident) associated with a LARIAT leak. There have been at least two other credible anecdotal reports of TIAs associated with discovery of a late opening LARIAT leak I’m aware of, but this is the first such account in print.
I realize not all of our readers will find a direct relevance in LAA isolation, ligation, strokes and leaks, etc., but I trust there will be areas and issues that each of you will find worthwhile in this special case study edition. We will return to our more varied topic format in the October and December issues.
Left atrial appendage ablation, isolation and closure via occluding devices such as the Watchman and minimally invasive ligation methods such as the LARIAT procedure and Atriclip LAA clamp have been increasing in interest among cardiologist and patients, alike, around the world in recent years. For the most part, these new methods of rendering the LAA much less a major source of stroke risk than it often is for afibbers, have proven reasonably safe in skilled hands, and with increasing evidence of efficacy.
However, as my recent experience detailed in this issue underscores, no cardiac procedure is risk free and as with any new technology such as this, there is always a discovery process with new lessons learned as we gain more experience with these new methods and devices as greater numbers of people over more time clarify the benefits and risks. And yet, by acknowledging such limitations when they arise, experts can take advantage of us ‘early adopters’ and I trust make these procedures even safer going forward.
I hope that my story below will help contribute, in some small way, toward greater understanding and more effective uses of these techniques and technologies to address the LAA. In my book, there is great potential benefit in having an array of effective and safe LAA closure devices, using several different methodologies, to best serve the widest array of patients who can benefit from both structural and electrical isolation of the LAA and/or from eliminating the need for anti-coagulant drugs (OAC). Especially, for those folks who cannot tolerate blood thinners, and for those that required OAC drugs mainly to prevent the huge percentage of AFIB-related strokes that originate within the LAA.
Let’s get to it and I hope you find the story interesting and informative.
Wishing you all good health and lots of NSR! Shannon