Doctors & patients are saying about 'A-Fib.com'...
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“I think your site has helped a lot of patients.”Dr. Hugh G. Calkins, MD Johns Hopkins,
Baltimore, MD
2026 AF Symposium
Challenging Cases in AF Management and Stroke Prevention
Challenging Cases in AF Management and Stroke PreventionThis is one of my personal favorite sessions, though it’s also one of the least attended (probably because people are leaving early to catch a plane home on the last day of the Symposium).—
In this Saturday afternoon session, doctors talk about their most difficult and challenging cases with honesty and humility. Presentations were 5 minutes long followed by 5-minute discussions. The presenters this year were:
David Keane, MD, Moderator
Dr. David Keane (St. Vincent’s Hospital, Dublin, Ireland), Moderator
Dr. John Day (St. Mark’s Hospital, Salt Lake City, Utah)
Dr. Edward Gerstenfeld (University of California, San Francisco, CA)
Dr. Young-Hoon Kim (Korea University Medical Center, Seoul, Korea)
Dr. Laurent Macle (Montreal Heart Institute, Montreal, Canada)
Dr. Francis Marchlinski (University of Pennsylvania, Philadelphia, PA)
Dr. Rodney Horton (Texas Cardiac Arrhythmia Center, Austin, TX)
91-year-old Tennis Player with Huge Left Atrial Appendage Opening
Rodney Horton, MD
Dr. Rodney Horton presented the challenging case of a 91-year-old man with persistent A-Fib who lead a very active life. He played tennis dally. (Dr. Horton said he thought this 91-year-old man could probably beat him in tennis.) The patient wanted to get off of anticoagulants because of his energetic lifestyle and because he didn’t like being dependent on anticoagulants. Also, he didn’t want an atrial clip occlusion device.
The Problem: The opening (ostium) of his Left Atrial Appendage (LAA) was immense. Dr. Horton described it as “huge and pretty scary looking.” No existing LAA closure device was big enough to close off the opening to his LAA.
Amplatzer Amulet & Meltzer knot (stock images)*
Strategy: Off-Label Innovative Closure Device
To modify the man’s ostium, Dr. Horton had to use an off-label hybrid strategy he developed. As a model, he used a condom filled to 43mm.
He used both a lobe of an Amplatzer Amulet device combined with a plastic suture loop in a Meltzer knot. It worked! And effectively closed off the patient’s LAA.
Editor’s Comments
Editor’s CommentsOne has to admire Dr. Horton’s creative and innovative thinking, and his persistence. The alternative was to leave this active 91-year-old tennis player on heavy-duty anticoagulation for life.
This would have directly affected his Quality of Life (QoL), an important consideration in the treatment of patients with Atrial Fibrillation. This patient is fortunate to have found Dr. Horton and his innovative solution that allowed him to return to his very active life. (*BTW: Patti was fascinated by this solution and looked up what a Meltzer knot was and made the illustration.)
