Failed lariat procedure

This morning Natale attempted a Lariat procedure which was not completed because too much scar tissue was present. I,m thinking about having a Watchman procedure. I May be able to stay here in Austin and have the Watchman inserted tomorrow. I would really appreciate hearing any information or thoughts you have about the Watchman. Thanks, CindyO

Hi Cindy,
Sorry to hear that your Lariat procedure had to be aborted, but that can happen on occasion. Particularly if there is some adhesion scar formed between the LAA and the outside of the Left Atrium or other adjacent structure to the LAA.

Also about 20% of people are not anatomically compatible with the Lariat due to too large or odd shape of the LAA relative to the pre-tied 40mm diameter Lariat suture that has to fit over the full length of the LAA. But Dr Horton in Austin, who does all the Lariat pre-qualification CT-Scan evaluations for Texas Cardiac Arrhythmia, would have examined your CT Scan to confirm you were anatomically okay prior to scheduling you.

Alas, while it isnt too common, it does occasionally happen that this pre-existing scarring or adhesions along the outside of the LAA between it and either the pericardial tissue possibly the outside of the LA itself, makes it impossible to fully cinch the Lariat snare all the way up to the hilt of the LAA where it joins the outside of the Left Atrium which is necessary to complete the job and this is something that cannot be known for sure until they are in there giving it a try.

As such, Dr. Natale would have had no choice but to cancel the procedure.

The Watchman is well developed now too and is a good choice, even in its own right, but especially if the Lariat isn't for you. There is a lot of good data with the Watchman now and it has been shown to be highly successful in getting people off the blood thinners as well. And there is good evidence that, like the Lariat, it results too in a further confirmed mechanical isolation of the LAA, which can help some even after having had an LAA isolation ablation. .

With the Lariat there is both electrical and mechanical isolation that is very robust since the LAA tissue withers and gets necrosed (dies) and partially re-absorbed such that there is nothing left to cause arrhythmia problems from what once was the LAA. But they are findingsome evidence that after the Watchman device is successfully installed and endothelialized there is mechanical LAA isolation to go along with the electrical isolation you had already with the LAA isolation ablation.

In any event, the Watchman is a good alternative and with a successful installation, which is around 94% statistically even with a fair number of first time Watchman EPs doing the work in those studies, that is a very good rate of success and its even higher in an experienced center like you are in now. The good news is that within 6 to 9 months maximum there will be full endothelial growth over the full covering of the Watchman device and the full opening mouth of the LAA, such that there will then be no possibility of it ever breaking free out of the LAA.

In your shoes now, I would go for the Watchman, especially with the experienced team you have there with Dr N and his colleagues who have done of lot of these and have been a major center for these studies on both the Watchman and the Lariet. Don't worry, you are in good hands.

I'll be shooting for my Lariat procedure there with Dr Natale and Dr. Burkhardt in 5 week on August 5th, so I'm right behind you!

For more reassurance Cindy and good information, go to this link and scroll to the very bottom of the full Video archive page on this site and select the video titled: 'LAA Closure: A viable strategy for Stroke Prevention' by Dr Vivek Reddy. This deals with the Watchman but much of the principle applies to the Lariat as well.

Best wishes for you Cindy and keep us posted.

Shannon



Edited 5 time(s). Last edit at 06/27/2013 03:53AM by Shannon.

Thanks, Shannon for taking the time to explain these two little-known procedures. yes, I knew that I might be one with too much scarring from my ablutions, but what complicated my case is a large amount of scarring on my right atrium. Natale thinks it's perhaps viral. This scarring made the base of the appendage too stiff and large.
I read quite a bit about the watchman, but was missing the inside information. Didn't ever study it as I was not expecting to have it installed, but I did know the basics, and that it had been approved and later removed, then reinstated for limited use by the FDA.

it's efficacy is about the same as Coumadin, but Natale pointed out that it has no gaps in protection. For example, when going to the dentist or having any procedure that includes bleeding, those on Coumadin must quit taking it for several days, thus increasing their risk of stroke. plus, one less med to take...

So, I may be here in August as well, having the Watchman procedure. I have to wait a month.

Best of luck to you on your medical journey. Keep us all posted and I will try to do the same!

Cindy

You are welcome Cindy, sorry you have to make another trip back down to Austin during the big Hot weather month ... It can get brutal there in August... Perhaps You'll be there in the week of August 5th when I get my crack at the Lariat.

Roughly 20% of people are found to have degree of pericardial to LAA adhesion, but those adhesions are not extensive enough to prevent completing the Lariat procedure for the majority of those 20% who are found to have those adhesion scars. Unfortunate luck for you Cindy, but I'm sure you'll do fine with the Watchman.

The main thing with both the Lariat and Watchman is that after a successful procedure, evn if some of the infrequent treatable complications arise temporarily, after those issues are resolved, we then inherit life long freedom from AC drugs with dramatic reduction in stroke risk overall, not to mention all the hassles and long term well known risky all the AC drugs bring to one degree or another.

Take care Cindy and PM me with your schedule when you get it set up. Maybe we will rendezvous this time?..

Shannon

PS Cindy,

An curious if you had to stay one night in the hospital after the aborted Lariat? I imagine they would have had to place both the endocsrdial catheter and the epicardial catheter with pericardial access achieved before they could determine you had too much adhesion around the LAA to complete the procedure??

Did they have to leave the pericardial chest tube drainin over night?
Thanks
Shannon

Hi Shannon -

Yes, the post op treatment is the same since my pericardium was punctured and Natale attempted to secure the lariat three times. Of course my leg is also punctured. After talking to him more extensively, he explained that I have mysterious scarring on the back of the right atrium that extends to the LAA. He says it is probably from a past viral infection. I felt fine as soon as the drain was removed from my chest. It was mildly painful while in place, but no big deal. My vein puncture is also small and painless because the catheter is small and not moved around extensively. Yes, you may see me in August. This hospital is very nice, a concierge hospital with a great staff. The food is edible, too! Good luck to you!

Cindy O

Cindy - I'm so very sorry to read of your ordeal and hope that soon, all will be in the past and you are once again enjoyng life in NSR.

On the scarring of your heart as related to a viral infection..... have you ever tested positive for Lyme?
While Lyme is a bacterial infection, it's known to reside in the connective tissue of the heart and could be the source of the scarring and it is known to cause atrial fibrillation.

If it is Lyme in remission, eventually, you'll probably want to address eliminating that, although it's not easily done. If it comes to that, let me know as I have a large collection of research and reports by Lyme experts I can share.

Special blessings to you, Cindy.

Jackie

Thanks, Jackie - I have never been tested for Lyme disease, so perhaps that is something I should look at. Thanks for your good wishes. I'm recovering very quickly and am enjoying life in NSR. I'm out of the hospital 48 hours post surgery, and feel strong and healthy. My big problem is BP - addressing that again now. Thanks for offering Lyme help. I'll keep you posted.

All the best to you - Cindy

Cindy,

I suggest you read Moore's The High Blood Pressure Solution. < [www.amazon.com];

George

Thanks Cindy,
That would be good, and ironic, if it works out to meet you finally in Austin after missing you by a few hours in San Francisco last year when you had checked out the morning I arrived for my meeting with Dr N! And yes I am familiar with the St.Davids having had my first ablation for persistent AFIB there in 2008 and was a 'guest' in one of their private suites for 5 days, so I got very familiar with their excellent level of care as well.

Keep me posted on your schedule, I arrive in Austin on August 1 and will likely stay through August 11 or 12 as we have relatives and friends in both Austin and Houston. I am giving myself a possible 5 days stint for the hospital stay with a couple extra days left open in Austin, just in case, for the Lariat even though the typical stay is for 3 night .. sometimes 4 nights. But just in case any pericardial effusion happens (I hope not but it does so in a little over 10% of cases) I want to bake in a few extra days to our plane tickets so I would have time to treat that with the Colchicine Dr. N would use to quell that inflammation and possible fluid build-up in the pericardial sack, should such and effusion occur.

I've got roughly a 90% chance that hiccup wont occur \in any event, so those are pretty good odds and am keeping my fingers crossed and will be prepared either way. The good news is any of the type of hiccups or complications they are seeing are all temporary and treatable.

Take care,
Shannon

It's hard to believe how good I feel - truly normal in terms of energy and appetite. I'm now enjoying the food of Austin... Of course there is no lariat assault to my heart, which must make a huge difference.

I own a copy Moore's book. I try to assiduously follow his plan, and it helps definitely to balance salt and potassium, but my BP is still very high. You've reminded me that it is time to reassess my eating habits.

Shannon - your plan sounds good, and I hope you are in the 90%! Natale gave me steroids to avert problems, and my blood sugar was affected, so I had a few insulin injections, but within 48 hours, all returned to normal, fortunately. I'll keep in touch.

Cindy O

Thanks for the update Cindy, keep my posted on your August schedule. I'm just finished with my planning and will be leaving for Tejas three weeks from today ...

Take care,
Shannon

Hi Shannon -

Will keep you posted. I received an email today saying that I won't be eligible to be enrolled in the Watchman study until 30 days past my Lariat procedure, which was on 6/25.. Not sure what this means,.. but probably that then they will schedule me. I'll talk to Chantel there tomorrow.

Please keep me posted as well about how things go for you.

Sending you good thoughts -

Cindy

Hi Cindy,

I would give them a call and see if they know yet when Dr. Natale, and whom every else might be working with you on the Lariat, might be in Austin and able to do the Watchman procedure in August? At least then you could start making preliminary plans pending on you getting final approval and a set date and then know what your options would likely be. Assuming you will get the go ahead approval for the Watchman as I suspect you will. It could be they cant do a Watchman in August if their schedule is booked already, but I know in cases like yours where the first procedure could not be completed, for whatever reason, as was the case with your Lariat that had to be aborted, they will try to do whatever is possible to rearrange things to fit you in as soon as they can.

Would be nice if you were down the hall when my wife and I are there

Cheers!
Shannon