BOCA RATON — Boca Raton Community Hospital’s Christine E. Lynn Heart and Vascular Institute (LHVI) has made the first use in the state of Florida, and only the fourth use in the nation, of a recently FDA-approved device to exclude the left atrial appendage, a site associated with stroke in atrial fibrillation (afib) patients.
The AtriClip is being used at Boca Raton Community Hospital
James Morris, MD and medical director of the Institute recently implanted what is known as the AtriClip™ into a 71-year-old male patient with atrial fibrillation who had been admitted to the hospital suffering from an intracranial bleed. The patient has since been discharged in good condition.
Patients with atrial fibrillation, or irregular heartbeat, have a five times higher risk of suffering a stroke than people who don’t have the condition, according to the Framingham Heart Study, which followed more than 5,000 patients for more than 30 years.
Physicians believe this increased risk is associated with the failure of the left atrium to fully evacuate blood during atrial fibrillation. The blood then pools in a cul-de-sac within the left atrium called the left atrial appendage (LAA). The LAA is a small pouch attached to the left atrium containing irregular interior surfaces called trabeculations. In patients with atrial fibrillation clots can form in these areas. These clots can then migrate through the circulatory system, block circulation to key structures in the body and lead to stroke.
“We believe over 90 percent of clots form in the left atrial appendage,” said Dr. Morris. “By occluding, or cutting off blood flow into the LAA, we can dramatically reduce the chance of stroke for patients with afib.”
Prior to the development of the AtriClip, surgeons used a stapler to remove the LAA, or sutured the appendage shut. Studies, however, showed that only about 40 percent of these procedures successfully closed the LAA.
With the AtriClip, surgeons place the device around the left atrial appendage using minimally invasive or “keyhole” techniques, which provide significant benefits to the patient over conventional open-heart procedures. The AtriClip is then closed and functions as a clamp to cut off the blood flow between the LAA and left atrium. The LAA is then reabsorbed by the body over a short period of time.
“The left atrial appendage is much like the body’s appendix. It performs no physiologic function. It is simply a reservoir, if you will, for the heart’s left atrium,” commented Dr. Morris. “Thus, the logic behind the AtriClip is quite elegant. If the LAA presents all risk but no reward to the afib patient, why not simply eliminate it.”
Another significant benefit of the AtriClip procedure is the potential for afib patients not to have to take anticoagulation medications such as Coumadin, long a mainstay therapy for this patient population. “If one takes out the repository where clots form, it stands to reason there could be a concomitant elimination of the use of anticoagulants and their significant side effects.” said Dr. Morris.
Dr. Morris was quick to emphasize that this benefit was limited to afib patients and not those using anticoagulant therapy for conditions like deep vein thrombosis or after angioplasty. “While we are very encouraged relative to the two-fold benefits of the AtriClip procedure, it is essential that the public knows the therapy is applicable only to patients with atrial fibrillation and high risk for stroke,” he said. “For that particular patient population, this is a tremendous advance in the care we can offer.”