Interview with Dhanunjaya "DJ" Lakkireddy, MD, executive medical director for the Kansas City Heart Rhythm Institute at HCA Midwest Health, professor of medicine at the University of Missouri, Columbia, deputy editor for the the Journal of Atrial Fibrillation, and member of the Heart Rhythm Society (HRS) Board of Trustees and section steering committee chair for the ACC, explains recent trials and advances in left atrial append (LAA) occlusion and how the therapy helps atrial fibrillation (AFib) patients.
The LAA has been implicated as the primary location where clots form inside the heart during AFib episodes, which can then break loose and travel up to the brain and cause a stroke. Anticoagulation drugs are usually prescribed to prevent clot formation in these patients, but the medication also increases the risk of bleeding in these patients. The risk can rise as patients age and if they already have conditions like stomach ulcers.
LAA occluders, both surgically placed clips lassos or sutures, or transcatheter devices, seal off the appendage so clots can no longer form there. This can eliminate the need for oral anticoagulants, which patients usually taking a m ore mild antiplatelet drug. The LAA occluders can help patients at high risk for bleeding and patients who are chronically non-compliant about taking their anticoagulants.
"There is a place for oral anticoagulation, but when you look at the morbidity imposed by anticoagulants and the adherence issues, the left atrial appendage occluder devices are an excellent alternative," Lakkireddy explained. "There is no doubt that these devices work very well
Unlike many other technologies, the left atrial appendage closure devices actually took a long time to come into the market place, taking more than 15 years of research, Lakkireddy said. But clinical trial evidence did does show closing off the LAA is an effective treatment and can enable a patient to go off of anticoagulants.
In 2015 the Boston Scientific Watchman device was cleared by the U.S. Food and Drug Administration (FDA), and a second device, the Abbott Amulet was cleared in 2021.
Find out more about recent LAA occluder advances in an interview with electrophysiologist Devi Nair, MD in the VIDEO: Advances in left atrial appendage occlusion technology.
Dave Fornell has covered healthcare for more than 17 years, with a focus in cardiology and radiology. Fornell is a 5-time winner of a Jesse H. Neal Award, the most prestigious editorial honors in the field of specialized journalism. The wins included best technical content, best use of social media and best COVID-19 coverage. Fornell was also a three-time Neal finalist for best range of work by a single author. He produces more than 100 editorial videos each year, most of them interviews with key opinion leaders in medicine. He also writes technical articles, covers key trends, conducts video hospital site visits, and is very involved with social media. E-mail: dfornell@innovatehealthcare.com