The left atrial appendage closure device offers patients with non-valvular atrial fibrillation (AFib) an alternative to taking warfarin therapy and the side-effects, such as bleeding, that come with the therapy. This procedure has also been shown to decrease a patient’s stroke risk by as much as 77 percent in clinical trials.
In a procedure that takes about an hour, the left atrial appendage closure device is inserted into the heart via a catheter placed in a vein in the upper leg. Once in place, the wire and mesh device opens like an umbrella to block the LAA. At the Heart and Vascular Center, the procedure is performed in our state-of-the-art Electrophysiology Lab. Patients typically spend one night in the hospital, and most are able to stop taking a blood thinner within 45 days, the time it takes for heart tissue to grow over the implant and create a permanent barrier to clot formation.
Left Atrial Appendage Closure Device Expertise at Wake Forest Baptist
David Zhao, MD, and Patrick Whalen, MD, were among the first cardiovascular experts in the state offering the left atrial appendage closure device and in January 2021, Wake Forest Baptist Health implanted their 600th left atrial appendage closure device.
"We have seen a 66 percent increase in the number of AFib cases in the past 20 years. When I talk to patients about AFib, we talk about improving their quality of life and their quantity of life," Whalen said. "We want patients living longer. One important way to improve longevity is by stroke prevention. Stroke is the major threat to longevity of patients with atrial fibrillation. Most of these strokes are generated by clot formation in the left atrial appendage. Many of these patient cannot tolerate a blood thinner which is standard treatment. Implanting a device to close the left atrial appendage brings peace of mind to patients fearful of a stroke," said Whalen.
"We have made great advancements in controlling atrial fibrillation through catheter ablation, however this does not completely eliminate the need for blood thinners. Many patients cannot safely tolerate blood thinners over a lifetime. Bleeding risk, anemia, and falls are real concerns. Closing the left atrial appendage allows us to reduce stroke risk without the need for lifetime anticoagulation. We have been involved in device development and are actively involved in clinical research trials in this area. We have implanted over 600 Watchman along with other catheter based devices and surgical tools for stroke prevention. For patients whose AFib is not well controlled or for patients who can't take blood thinners, this is a significant step in helping them have a better quality of life. We are excited to be actively involved in developing the next generation of tools for stroke reduction and are now combining catheter ablation and left atrial appendage closure in a single procedure for certain patients."
Blood Thinners vs. the Left Atrial Appendage Closure Device to Treat AFib
Blood thinners are the most commonly employed long-term stroke-prevention therapy for people with the most common form of AFib, and the most commonly prescribed blood thinner is warfarin (usually dispensed under trade name Coumadin). But warfarin has a number of drawbacks, including increased risk of serious bleeding, the need for regular monitoring, some dietary restrictions and negative interaction with numerous prescription and over-the-counter medicines. Plus, some people simply can’t tolerate blood thinners.
Rather than thinning the blood to prevent clots from forming, the left atrial appendage closure device closes off the LAA, a small pouch in the upper left chamber of the heart. Research indicates that about 20 percent of all ischemic (clot-related) strokes happen in people with AFib and that 90 percent of these can be traced to clots originating in the LAA.
About the Watchman Device
Manufactured by Boston Scientific Corp., the Watchman was approved by the federal Food and Drug Administration in March 2015. Available internationally since 2009, it has been used to treat more than 15,000 patients in over 50 countries.
In early February 2017, the Center for Medicare and Medicaid Services announced that Medicare would cover the cost of the Watchman device and the procedure to implant it in patients who meet certain criteria.