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Considering a LAA Occlusion Closure? Watch Out for Nickel Allergy

Approximately 8% of us have a nickel allergy. If you’ve had your ears pierced (or some other body part) and had to use “hypoallergenic” jewelry, you most likely have a nickel allergy. (Patti says gold earrings also work for her nickel allergy but are more costly.) It is one of the most common causes of metal sensitivities in people.

For more info on Nickel allergy, go to Two Cents About Nickel from American Academy of Allergy, Asthma & Immunology.

If you’re one of the many A-Fib patients looking to close off their Left Atrial Appendage, be aware if you have a nickel allergy, you have limited choices of an occlusion device.

Thanks to Frances Koepnick for alerting us to this problem. She had to cancel having a Watchman implanted because of her nickel allergy.

Nickel in Occlusion Devices

Heart illustration showing the Left Atrial Appendage at A-Fib.com

Heart illustration showing the Left Atrial Appendage

Watchman occlusion device (Boston Scientific): The Watchman contains Nitinol, a metal that is approximately 50% nickel and 50% titanium. The manufacturer states that individuals with a nickel allergy are ineligible for a Watchman implant.

Amplatzer Amulet occlusion device (St. Jude Medical-Abbott): The Amulet also contains nitinol and, therefore, has the same implications for nickel allergy.

Hyper-sensitivity Diagnostic Test Results

Standard skin/patch testing is considered unreliable for metal allergy testing. “Metal-LLT (Lymphocyte Transformation Testing)” is a diagnostic test used by allergists to measure hypersensitivity responses.

Below is a sample of test results showing nickel sensitivity:

Metal Challenge Stimulation Index  Range (percentile based)
Aluminum 0.9 Normal (Non-Reactive)
Nickel 4.2 Reactive
Iron 0.7 Normal

For LAA Closure: What To Do About a Nickel Allergy?

Right now Frances’ only option seems to be the Lariat II device (SentraHEART Inc).

The Lariat II does contain Nitinol, but it is gold plated. The gold plating acts as a barrier to nitinol/nickel exposure. Though formerly approved by the FDA, the Lariat II device is currently in a second (extended) “Amaze”clinical trial which is due to be completed in December 2019.

For more about the SentraHeart, see my article, Lariat II Suture Delivery Device.

Additional warning: today’s pacemaker leads may also contain nickel.

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