Left atrial appendage closure- is this a cure?

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Hi - I'm new here - had a stroke 6 weeks ago and told it was a-fib. No advice from doctors so did an internet search and came across left atrial appendage closure. Apparently they've been doing this for about 15 years and when it's done you can come off anticoagulants. This would be great as I've already moved from apixaban to riveroxaban due to side effects and after only 5days on riveroxaban I feel terrible. Does anyone know anything about this? I've asked to be referred to Papworth as they seem to be the experts on this.

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  • Posted

    It stops the need for warfarin or a NOAC and is just as effective as them in stopping a stroke. There are at least two devices being used at the moment the Watchman Device and the Amplatzer Amulet.

    There is/was a trial programme on the Amplatzer at 10 UK hospitals. I asked the makers if I was a suitible patient and they referred me to the Brighton trial in March but I heard no more. I have asked my GP to see what he can do for me.

    I am actually keen enough on it to pay probably  £15K to have it done privately.

    My GP is not that keen on be being on Warfarin for several reasons and NOACs are contra indicated as I have a tissue aortic valve.  

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    • Posted

      Thanks for your quick reply. I've asked my gp to refer me to Papworth but would be willing to pay if I can't get it on the NHS. It looks relatively straightforward. I'm annoyed my stroke doctor wouldn't speak to me about it - when I asked if he'd heard of it he just said 'yes' - nothing else. Bearing in mind he'd just told me it was a 'risk we would have to take ' putting me on anticoagulants as I'd had a small bleed, I'm not impressed.

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    • Posted

      I asked anout it last year at the NHS hospital where I had a pacemaker fitted. The EP said that we do that and we will talk about in four months when you come to outpatients. That was 14 months ago and no follow up, That is another that my GP has tried to expidite without response.

      I could have had the Watchman done privately at London Bridge Hospital two years ago but thought it better to have my pacemaker fitted first.

      Overall I think that the amplatzer is better than the Watchman. There is another procedure where the appendage is removed by keyhole surgery,

      NICE are not so keen on that one.

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    • Posted

      Hadn't heard of the removal one - don't think I'd be too keen to be honest.! Iim hoping to be able to discuss the options with someone who is knowledgeable about it. I'll let you know if I get anywhere.

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    • Posted

      It can of course also be rmoved better during cardiac surgery. I was not in AF when I had my aortic valve replaced. That happened a consequence of the operation as it does I later found to over 30% of patients. The heart they said does not like being handled.
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    • Posted

      There are a lot of things they don't tell you till after! I have slow afib so I don't know when i have it. That's good but it meant I didn't get any warning before the stroke. Luckily I didn't have any side effects but it's a steep learning curve.

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    • Posted

      Gildy, How did your quest for the device go.

      The NHS trials although sucessful have not resulted in NHS funding to continue with them and it could be as long as two years before they are provided.

      Cardiologist I have been to was part of the trial and along with private patients has fitted 120. I have said yes to having it done privately and waiting for a confirmed date for next month.

      The actual procedure just takes two hours. In at 8am, he starts at 9am and after recovery should be on my way home at 2pm... just under £10K lighter. The Amplatzer is by far the better device and after it is fitted no more blood thinners just aspirin for six months.

      He does two follow up ultrasound scans to check it OK.

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    • Posted

      Hi, I'm new here. I have had PAF for about 7 years (about 4-5 episodes a year of less than 3 hours duration each) and see my cardio once a year. I refuse to go on the new NOAC   As, bar one, they have no antidote. You could very easily bleed to death in an accident or just falling off your bike and sustaining an internal bleed. Warfarin is not an option either. Too many constraints and now a link to dementia. My cardio suggested LAA occlusion but It is not available on the NHS. However, even this option has its detractors (gleamed from an internet article). At the moment I am on Flecainide 150mg slow release which keeps the PAF mostly under control. I take 1.25mg Bisoprolol whenever my HR exceeds 85. When in afib my symptoms are always an overwhelming feeling of doom and I know exactly when an episode starts and finishes. I have been told that blod clots tend not to form unless afib is at least 24 hours ongoing. Like everybody I want to be rid of this awful condition. I hope that as more LAA occlusions are being performed and there is greater positive info it will be worth having. Do you know if progress is being made? I live close to Brighton and wonder if some of their cardios are carrying out this new procedure - successfully! 

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    • Posted

      Derek,

      Like barty I live near Brighton and am prepared to pay given the alternative. I also live near Brighton and if you have the name /contact for the heart consultant. It would much appreciated.

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  • Posted

    I have found NOACs without an antidote, concerning life-long care programs or life-long clot/stroke registers catered for the inpatient, outpatient of concerned persons  are contra indicated because of the way drugs are put forward for single technology appraisals (STA) and multiple technology appraisals (MTA) and then preparation and documentation of NICE guidelines and clinical trials. From my viewpoint, there is debatable negligence of moral and ethical duties in areas of research & development. Just recently, Professor David Haslam, Chair of NICE, talks about the benefits of clinicians and patients making decisions together.

    I had a quicklook on internet & streaming media- 'left atrial appendage closure', it seems like it's an offshoot of surgical invasive medicine. The potential market could be lucrative in the private sector and a potential cost centre in the public sector.

    I saw a video of a surgeon feeding a catheter into a persons (patient) femoral vein, it juxtaposes to an illustration, releasing what looks like an elongated ballon catching the negative/positive pressure created by the heart pump directing the catheter towards the heart and left atrium; with the aid of what looks like an advanced  transthoracic echocardiogram (TTE)/ultrasound monitor connected to a large screen monitor as guide to where the heart surgeon deploys a recomended technology, contemporary technological solution*, or clot busting medicine, or innovative combination of the two - a bit like a 'dialysis clot flush'.

    I think the decision to use either invasive of NOAC solutions for management of existing and potential clots depends on the assessment* of the person before being treated as the patient - this is where guidelines can be improved.

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