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Doctors & patients are saying about 'Beat Your A-Fib'...


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Pierre Jaïs, M.D. Professor of Cardiology, Haut-Lévêque Hospital, Bordeaux, France

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Dr. Wilber Su,
Cavanaugh Heart Center, 
Phoenix, AZ

"...masterful. You managed to combine an encyclopedic compilation of information with the simplicity of presentation that enhances the delivery of the information to the reader. This is not an easy thing to do, but you have been very, very successful at it."

Ira David Levin, heart patient, 
Rome, Italy

"Within the pages of Beat Your A-Fib, Dr. Steve Ryan, PhD, provides a comprehensive guide for persons seeking to find a cure for their Atrial Fibrillation."

Walter Kerwin, MD, Cedars-Sinai Medical Center, Los Angeles, CA


Left Atrial Appendage Closure

2024 AF Symposium Spotlight Session: Unlocking Arrhythmias: vMap’s AI-Driven Revolution (Vector Medical)

Dr. Jagmeet Singh

2024 AF Symposium

Unlocking Arrhythmias: vMap’s AI-Driven Revolution (Vector Medical)

Dr. Jagmeet Singh of Mass General, Boston, MA gave a Spotlight Session talk on a technology that could greatly facilitate how EPs locate and ablate arrhythmia spots in the heart.

Using standard, non-invasive 12-lead ECGs, Vector Medical’s vMap system utilizes “advanced algorithms and AI-based techniques” [Artificial Intelligence] to locate and identify source locations of both focal and fibrillation-type arrhythmias.

Beat-by-Beat 2D and 3D Cardiac Maps

The vMap system uses advanced proprietary algorithms to generate beat-by-beat 2D and 3D cardiac maps to provide a visualization of the probabilistic source of a particular arrhythmia. The core technology, the computational ECG mapping system, was created from a comprehensive library of more than one million model-predicted electrograms. 

One study included 225 patients in a blind multi-center study. VMap maps were compared to successful ablation studies with an overall accuracy of ±97%. Mapping took an average time of 48 seconds.

VMap reduced the time from mapping to treatment, procedure duration, and fluoroscopy.

vMap FDA Cleared―Future Uses

The vMap system is FDA cleared and has undergone “extensive clinical validation”.

Dr. Singh anticipates that in the future, vMap will integrate ECG with AI alongside electroanatomical maps. It will also be used with CT and MRI to better visualize A-Fib spots in the heart.

Editor's CommentsEditor’s Comments
VMap’s Analysis Tool Medical Breakthrough! The Vector Medical vMap system’s AI-based algorithms represent a medical breakthrough and groundbreaking development in arrhythmia care. Doctors can now compare a particular patient’s ECG to a huge database of other ECGs. The vMap system using AI then computes rapidly and accurately where an A-Fib signal(s) is coming from in a particular patient’s heart. To date, it’s the only FDA-cleared non-invasive system that utilizes just a 12-lead ECG to map arrhythmias.

To date, Vector Medical’s vMap system’s is the only FDA-cleared non-invasive system that utilizes just a 12-lead ECG to map arrhythmias.

The vMap analysis tool will improve cardiac ablation by enabling EPs to rapidly and accurately map where A-Fib signals are coming from. It will also increase procedural efficiency as well as optimize workflows. The treatment of patients will be improved. One would expect the success rate of catheter ablations to advance. And according to Dr. Singh, vMap decreased ablation procedure time by about 26%. It potentially increased procedure volume by 20% thereby possibly improving the EP catheter lab’s bottom line.
Should Patients Seek Out EPs Who Use vMap? Does this mean that patients should only seek an ablation from an EP or center that uses vMap? Right now, it’s too early to assert this. But this may soon be the case. vMap is being used in clinical practice and is being adopted at new hospitals throughout the U.S.
Patients should ask their EP about technologies that identify sources in addition to PVI or inquire directly about hospitals that offer vMap at VektorMedical.com.
(Experienced master EPs may not need this. Other mapping systems may prove as effective.)

VMap System Useful for Newer EPs: One would expect that the vMap system may become very useful for newer EPs showing them more easily where to look for A-Fib signals, especially whether to look at the left or right atrium first. It may also improve ablation outcomes.

Research
Krummen, D. E. et al. Forward-Solution Noninvasive Computational Arrhythmia Mapping: The VMAP Study. Circulation: Arrhythmia and Electrophysiology. 2022;15. Sept 7, 2022, Volume 15, Number 9. https://www.ahajournals.org/doi/10.1161/CIRCEP.122.010857 https://doi.org/10.1161/CIRCEP.122.010857
Return to 2024 AF Symposium Reports
If you find any errors on this page, email us. Y Last updated: Thursday, July 18, 2024

2024 AF Symposium: A Case of Closing Off the LAA with the LAMINAR Device with Pre-Recorded Video

Dr. Devi Nair

2024 AF Symposium

A Case of Closing Off the LAA with the LAMINAR Device with Pre-Recorded Video

Dr. Devi Nair from St. Bernards Medical Center in Jonesboro, AR presented a pre-recorded case of Left Atrial Appendage closure using the LAMINARLAA device (Johnson and Johnson/Biosense Webster).

Closing off the Left Atrial Appendage (LAA) is increasingly necessary in more complicated cases of A-Fib ablation. If for whatever reason the LAA is no longer contracting or pumping out properly, clots can form and cause a stroke. (Some advocate that the LAA should be routinely closed off in all A-Fib patients to prevent a stroke, because 90% to 95% of clots come from the LAA.)

Click to open ANIMATION: LAMINAR LAA closure device

Using the LAMINAR Device

In a pre-recorded case, Dr. Nair worked on a patient who needed their LAA closed off. In the upper left frame of this slide, the LAMINAR catheter is shown with the ball extended which is used to close off the LAA.

We saw Dr. Nair using Ultrasound and TEE (3D) to position the ball into the ostium of the patient’s LAA. The  ball has tiny hooks which grab the LAA ostium walls. Currently, there are two sizes of the ball―12mm and 16 mm to fit into different patient’s anatomy. (More sizes are in development.)

The LAMINAR catheter device; (Upper left frame) the LAMINAR catheter is shown with the ball extended which is used to close off the LAA.

Laminar LAA Closure/Elimination Device

Once the ball is properly positioned, the table top device above is used to rotate the ball counterclockwise to “plicate” or twist the LAA till it closes. The black knob is used to twist the ball in graded increments. The numbers tell the operator the degree of rotation (15-20°at a time). Dr. Nair described the table top device as very stable and that it allows very precise movements. It locks in place after a particular rotation.

Dr. Nair said that she could step away if she wanted to and that the table top device lets her operate at times hands free. Dr. Nair explained that the ball does not and should not touch the back of the LAA. The whole process takes 16 minutes with testing taking only 60 seconds done in real time.

Laminar 45 day pre and post implant

Repositioning the LAMINAR Device

While we were watching, Dr. Nair wasn’t happy with the first positioning and rotation of the ball. She simply released the mechanism allowing the LAA to return to its normal position. Then she started the process again.

The Disappearing LAA

Once Dr. Nair had positioned the catheter ball properly and twisted the LAA shut, she locked it in place after testing for leaks with a contrast agent.

Comparing Watchman (left) Amulet (center) Laminar (right) occlusion devices.

To those of us watching, it looked like the LAA had basically disappeared. Dr. Nair showed a slide of the LAA pre and post 45-day implant where the LAA was removed. Only a very small ball is left inside the LAA after it is closed off.

Dr. Nair also showed how the size of the closed off LAMINAR compares to the protrusions of the installed Watchman FLX and Amulet LAA closure devices.

The LAMINAR LAA closure/elimination device has been used in Europe for 3 years and is now in its third generation. European patients have had as many as 3 years of follow-up. In the U.S., it’s currently in clinical trials and aims to enroll 1,500 patients across up to 100 sites.

Editor's CommentsEditor’s Comments
Experts Already Using the LAMINAR LAA Closure Device: I was surprised at how many of the expert panelists and other operators were already familiar with and using the LAMINAR LAA closure device, including Dr. Vivek Reddy of Mount Sinai in New York. Dr. Reddy explained that the anatomy of the patient’s LAA really doesn’t matter, as long as the device doesn’t touch the posterior wall of the LAA.
To me the LAMINAR device looks full proof, but of course we will have to wait on clinical trials and real-world experience to see how it works out in practice.
Medical Breakthrough! The Laminar LAA elimination device is a potential medical breakthrough innovation!

Click to open ANIMATION: LAMINAR LAA closure device

Like many great innovations, the Laminar LAA elimination device seems remarkably simple and easy to use. It could revolutionize the way LAAs are closed off today. And because it takes so little time to insert, it could be positioned at the same time as a catheter ablation.
Most importantly, by actually eliminating the LAA rather than simply closing it off, it may be much better for patients offering fewer leaks, complications, intrusive metal devices in the heart, etc. Also, by actually eliminating the LAA, it could possibly prevent non-PV triggers in the LAA from affecting a patient’s A-Fib.
LAMINAR May Replace Other LAA Closure Devices: In the future, current LAA closure devices such as the Watchman (Boston Scientific) and Amulet (Abbott) may be superseded by the Laminar device.
Return to 2024 AF Symposium Reports
If you find any errors on this page, email us. Y Last updated: Thursday, July 18, 2024

New “2023 Guideline for the Diagnosis & Management of Atrial Fibrillation”

Links updated: 12-21-23

Important for all A-Fib patients: The newly issued 2023 Guideline for the Diagnosis and Management of Atrial Fibrillation. The guideline includes new evidence to guide your cardiologist and electrophysiologist in the treatment of your Atrial Fibrillation. It was last updated in 2014 and supplemented in 2019.

Cardiologists, electrophysiologists, surgeons, pharmacists, patient representatives and other stakeholders all collaborated on the updated recommendations.

First issued in 1980, the American College of Cardiology (ACC) and the American Heart Association (AHA) develop and publish these guidelines without commercial support, and members volunteer their time to the writing and review efforts.

ACC/AHA develop and publish these guidelines without commercial support, and members volunteer to write and review them.

ACC/AHA/ACCP/HRS: The 2023 Guideline is endorsed by four medical organizations: American College of Cardiology (ACC), American Heart Association (AHA), American College of Clinical Pharmacy (ACCP), and Heart Rhythm Society (HRS).

A Few of the Important Updates for Patients: I am still reading/studying this document—it’s 171 pages long. Here are a few updates that reflect important shifts in the treatment of A-Fib patients:

• Stages of atrial fibrillation: recognizes A-Fib as a disease continuum that requires a variety of strategies at the different stages;
• A-Fib risk factor: recognizes lifestyle and risk factor modification as a pillar of A-Fib management to prevent onset and progression;
• Catheter ablation of A-Fib: can be first-line therapy; Recognizes the superiority of catheter ablation over drug therapy for rhythm control;
• Left atrial appendage occlusion devices: recognized for safety and efficacy.

Steve Ryan at the 2023 AF Symposium

If you read A-Fib.com regularly, you know these topics have filled my posts for years. I write about these topics after reading the newest research, evidence and findings, querying the experts and learn the latest innovations at the annual AF Symposiums from presentations by leading electrophysiologists, cardiologists, scientists and researchers (read my 2023 AF Symposium posts).

I’ll write more about these changes.

You Can Read it Yourself. It’s available on the websites of the American College of Cardiology (JACC.org) and the American Heart Association (ahajournal.org).

Newly released: 2023 ACC/AHA/ACCP/HRS Guideline for the Diagnosis and Management of Atrial Fibrillation: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines; Issued by American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines; See www.jacc.org or www.aha.org.

 

2023 AF Symposium Spotlight: Ground-Breaking LAA Elimination Device

For A-Fib patients, perhaps the most innovative and potentially ground-breaking presentation at this year’s AF Symposium was by Dr. Saibal Kar of Cardiovascular Associates at Los Robles Hospital in Thousand Oaks, CA.

Laminar LAA closure device

In a Spotlight Session on Friday, he described a new device for closing off (“eliminating”) the Left Atrial Appendage (LAA). The LAA is where 90%-95% of Atrial Fibrillation clots and strokes come from.

The Laminar LAA elimination device is a potential medical breakthrough innovation! It takes little time to insert, it could be positioned at the same time as a catheter ablation. This could revolutionize the way LAAs are closed off today.. Learn all about it in my report: Spotlight Session: Laminar LAA Closure/Elimination Device.

 

2023 AF Symposium: Innovative A-Fib Ablation Plus LAA Closure in One Procedure

This report from the 2023 AF Symposium is about an innovative treatment for A-Fib patients―combining A-Fib ablation with the insertion of a Left Atrial Appendage (LAA) occlusion device in a combined procedure.

Closing off the Left Atrial Appendage has become an important topic for patients looking to be A-Fib free.

Many A-Fib stokes originate in the Left Atrial Appendage. And many recurrences of A-Fib come from the Left Atrial Appendage, too.

Inserting a Watchman occlusion device to close off the LAA has become a relatively simple and fast process. Combining it with a catheter ablation doesn’t add much time to the ablation procedure.

This treatment strategy is currently in use in many countries overseas, but isn’t yet common practice in the U.S.

Dr. Walid Saliba of the Cleveland Clinic Foundation in Cleveland, OH explained how patient selection is important in this combined procedure. To learn more read my report…

 

2023 AF Symposium: Ablation Combines with LAA Closure in One Procedure

2023 AF Symposium

Ablation Combines with LAA Closure in One Procedure

Walid Saliba, MD

Dr. Walid Saliba of the Cleveland Clinic Foundation in Cleveland, OH, discussed an innovative treatment for A-Fib patients―combining A-Fib ablation with the insertion of a Left Atrial Appendage (LAA) occlusion device in a combined procedure. (This treatment strategy is currently in use in many countries overseas, but isn’t yet common practice in the U.S.)

Patient Selection

Dr. Saliba explained how patient selection is important in this combined procedure.

The idea patient with atrial fibrillation needing an ablation would also have a high risk of stroke but couldn’t tolerate anticoagulants because of a high risk of bleeding.

Advantages of Combining PVI with LAA Closure

While these two procedures (A-Fib ablation and LAA closure) are typically done separately, combining them in one procedure has many potential advantages. Both procedures:

• require access from the groin to the left atrium

• initiating oral anticoagulation around the time of the procedure

Dr. Saliba made the following points:

1.Combining these two procedures reduces the risk of complications. (For example, one only has to make a transseptal puncture once rather than at two different times.)

2. Patients prefer only having to have one procedure rather than the hassle of going to the hospital twice for two different steps.

3. Combining these two procedures reduces the potential risk of bleeding.

Reimbursement Problem in U.S.

Dr. Saliba described how in the beginning (2015) it was difficult to be reimbursed for combining two different procedures at the same time. But eventually he was able to convince the powers that be that this was good for certain patients and actually saved the hospital money.

Source of A-Fib Recurrences

Dr. Natale and Dr. Saliba discussed that many A-Fib recurrences come from the Left Atrial Appendage. Inserting an LAA occlusion device when performing an ablation might prevent the mapping and ablating of non-PV triggers in or around the LAA. (This is less of a problem with the Watchman than with the Amulet device which actually masks off the LAA area with a metal disc.)

High Success, Low Complication

Dr. Saliba and his colleagues at the Cleveland Clinic have performed this combined procedure on more than 240 patients with one-year follow-up. Their success rate is high with low complications. Patients stayed in the hospital for a day.  Over 95% of their patients are eventually off of anticoagulants.

Half of their patients received the original Watchman, while the other half got the Watchman FlX. Leaks around the Watchman were only around 2.2% and were less than 2mm. At 90 days leaks were around 25% with less than 3mm. Dr. Saliba hasn’t noticed any problems with LAA remodeling, pressure, or scarring of the Left Atrium wall.

OPTION Trial Revelations to Come

The OPTION Trial is a clinical study of patients with non-valvular A-Fib. It compares outcomes of a combined ablation + LAA occlusion procedure versus catheter ablation alone followed with anticoagulation.

Specifically, the study is to determine if the WATCHMAN FLX occlusion device placed at the time of the ablation is a reasonable alternative to continuation of oral anticoagulation following catheter ablation. The results of this trial will be available in 2024.

Editor's Comments Editor’s Comments

Combining PVI with LAA Closure Medical Breakthrough! Combining a catheter ablation for A-Fib (PVI) with the insertion of a Watchman occlusion device seems a major improvement for patients, as well as reducing or eliminating a major source of worry for electrophysiologists (EPs).
One day, hopefully soon, everyone getting a catheter ablation will also have an occlusion device inserted in one procedure.
Free from Most Stroke Risk: Inserting a Watchman device to close off the LAA has become a relatively simple and fast process. Combining it with a PVI doesn’t add much time to the ablation procedure. And Dr. Saliba’s research demonstrated that it works!
The Left Atrial Appendage (LAA) is where most clots and strokes come from in patients with non valvular A-Fib. Patients getting a catheter ablation generally leave the hospital A-Fib free.
Nevertheless, they are still considered at some risk of stroke. Current guidelines dictate continuation of stroke prevention with oral anticoagulation despite a successful ablation. Having the LAA closure device offers protection against stroke without the ongoing bleeding issues of oral anticoagulation.
Patients Would Choose/Prefer This Combination Procedure: If you offered the average A-Fib patient the chance to be protected from a stroke at the same time they are made A-Fib free by a catheter ablation, most patients would choose the combination procedure.
They would only have to be hospitalized once and wouldn’t have to return weeks later to have their LAA closed off, as is common practice in the U.S. today.
They would have better peace of mind and quality of life knowing they are largely protected from having an A-Fib stroke.

And their doctor wouldn’t have to worry about them going off their anticoagulant and developing a clot in their LAA.

If you find any errors on this page, email us. Y Last updated: Thursday, May 11, 2023

Return to 2023 AF Symposium Reports

2022 AF Symposium Spotlight: Innovation in Development to Seal the Left Atrial Appendage

The CLASS LAAO

Sometimes the method to close off the Left Atrial Appendage, doesn’t make a complete closure. It can leak. I’m very excited about this new product. Dr. Jamie Kim of the Catholic Medical Center in Manchester, NH, presented one of the most innovative and promising new developments for patients to close off their LAA.

Instead of relatively hard, rigid structures which don’t always conform perfectly to the LAA opening and thus may leak, the CLASS LAAO system from Conformal Medical, Inc. uses a different type of conformable foam-based fabric to seal off the LAA. Read this short Spotlight summary for more about this promising new device.

Go to my 2022 AF Symposium page with all my reports.

A-Fib Catheter Ablation Combined with Left Atrial Appendage (LAA) Closure

In the People’s Republic of China (and other countries) catheter ablation for Atrial Fibrillation is often combined with closure of the Left Atrial Appendage (LAA) in one procedure. This means A-Fib patients can have a Watchman occlusion device installed at the same time as their catheter ablation.

While it may be common practice in some locales, there is limited research data on this combined procedure and, in particular, with patients with prior stroke. That’s why this study in China was conducted.

There is limited research data on this combined procedure and, in particular, with patients with prior stroke.

Aim of this Study: To compare the safety and efficacy of combined catheter ablation with closure of the Left Atrial Appendage (LAA), especially for A-Fib patients who have had a prior stroke.

Study Design: This retrospective study enrolled 296 patients who underwent combined procedures of A-Fib catheter ablation and LAAC. Patients were divided into two groups: 81 patients with prior stroke (Stroke group) and 215 patients without prior stroke (Control group).

Combined procedures were successfully performed in all the patients.

Follow-up Findings: The researchers followed-up with patients at a mean of 20 months.

Both the Stroke group and the Control group (without prior stroke) were relatively A-Fib free after catheter ablation. (Stroke group: 64.2%, the non-stroke control group: 68.4%).

The relative risk reductions in stroke and bleeding were around 80% in the stroke group and 62% in the control non-prior stroke group.

Conclusion: The researchers wrote: “The combination of catheter ablation and LAAC (Left Atrial Appendage Closure) is safe and effective in selected AF patients with prior stroke.”

Editor's Comments about Cecelia's A-Fib storyEditor’s Comments

There are several limitations to this study. This is a single-center retrospective study with a moderate sample size.
Despite the limitations of this study, for A-Fib patients the combination of catheter ablation and Left Atrial Appendage (LAA) closure appears safe and effective.

Currently, U.S. patients have to wait 3 months after a catheter ablation to have a Watchman inserted. Why must patients wait, why endure months of anticoagulants usage? But, more research is needed to confirm the conclusions of these researchers.

Reference
Mo, B et al. Combined Catheter Ablation and Left Atrial Appendage Closure in Atrial Fibrillation Patients with and without Prior Stroke. Journal of Interventional Cardiology, Volume 2021, Article ID 2138670. https://www.hindawi.com/journals/jitc/2021/2138670/ https://doi.org/10.1155/2021/2138670

 

Spotlight Session: Clinical Experience with the CLASS LAAO System

2022 AF Symposium

Spotlight Sessions: Features products or devices usually still in development or not yet FDA approved. They give us a glimpse into what the future of A-Fib treatment may look like.

Spotlight Session: Clinical Experience with the CLASS LAAO System

Dr. Jamie Kim

Dr. Jamie Kim of the Catholic Medical Center in Manchester, NH, presented one of the most innovative and promising new developments for patients to close off their Left Atrial Appendage (LAA).

The CLASS LAAO

Instead of relatively hard, rigid structures which don’t always conform perfectly to the LAA opening and thus may leak, the CLASS LAAO system from Conformal Medical, Inc. uses a different type of conformable foam-based fabric to seal off the LAA.

Complete Seal

The CLASS is designed to conform to a broader range of LAA sizes and shapes.

In the animation we saw, the foam-like material expanded from the insertion catheter to fill the interior of the irregularly shaped LAA. Dr. Kim says the seal made by the CLASS is complete.

Easier To Use, Wider Applicability

The CLASS LAAO system catheter

The CLASS device is soft which allows for both easier positioning when inserted and greater conformability. It also didn’t seem to have any metal protrusions as one sees in the Watchman.

It comes in only two sizes. It also uses rows of anchors to lock the device in place in the LAA. It’s designed with a flexible Nitinol under skeleton. It can be re-captured, if necessary.

To compare the Watchman with the CLASS, see my report: The Watchman Device. There’s also a brief animation of how the Watchman is installed: The Watchman FLXTM Device: Closure of the Left Atrial Appendage.

Editor's Comments about Cecelia's A-Fib storyEditor’s Comments

Barring any problems in the clinical trials, the CLASS LAA closure device is a major medical advance for patients. The CLASS LAA closure device will likely become the choice of most EPs and will supersede both the Watchman and Amulet devices.

How Does LAA Closure for Atrial Fibrillation Affect Heart Pumping Ability?

Left Arial Appendage (LAA) closure is the cornerstone of stroke prevention in surgical treatment of A-Fib. The Left Atrial Appendage is closed off, cut out, stapled shut, or shut off with a clip. How does this affect the heart’s ability to pump blood?

Small Study to Directly Measure Pumping Effect of LAA Closure

In a very small study of the hybrid operation/ablation, seven patients were measured for cardiac output and left ventricular stroke volume just before the hybrid operation, directly after, then ten minutes later.

The hybrid operation/ablation, learn more at The Cox-Maze & Mini-Maze Surgeries and the Hybrid Surgery/Ablation

The researchers pointed out that “the LAA also has a contractile function and takes part in the LA contraction process, especially in patients in SR (sinus rhythm)”.

But five of the seven patients were in A-Fib and already had reduced ejection fraction (EF) (26%). (Normal EF is 50% to 75%.) Even in the patients in SR, their EF was only 46%.

Ejection fraction (EF) is a percentage of blood that is pumped out of the heart during each beat. A range of 50%-75% indicates your heart is pumping well, delivering an adequate amount of blood to the body and brain.

LAA Closure Lowers Pumping Pressure Long Term

The researchers pointed out that LAA closure “can result in lower systolic blood pressure on the long term” according to previous research. (“Systolic” is the top number in your blood pressure measurement and is the pumping force your heart exerts.)

The researchers also pointed out that the LAA is the predominant site of atrial natriuretic peptide (ANP) in the heart which can affect heart pumping “volume overload”.

No Significant Difference

The researchers found no significant differences in various pumping measurements, but the Left Ventricular Stroke Volume (LSCI) was affected (28 mLm² to 24 mLm², P-value 0.066).

Editor's Comments about Cecelia's A-Fib storyEditor’s Comments

Patients with Poor EF: In patients with poor heart pumping and contracting ability (EF below 50%) to begin with, this study suggests they aren’t affected much by losing their LAA. They probably wouldn’t even notice it was gone. But the jury is still out on how losing the LAA affects even A-Fib patients with poor Ejection Fraction (EF) long term.
Patients with Normal EF: However, this may not be the case with A-Fib patients with a normal EF. The LAA does have a contractile function, particularly in patients with larger size LAAs. (Do athletes have larger size LAAs due to their exercise?)  This small study did not address the cases of A-Fib patients with normal EFs.

What This Means for A-Fib Patients

This small study didn’t measure patients with a normal Ejection Fraction (EF) who had their Left Atrial Appendage (LAA) closed off or removed. Most likely the heart’s pumping ability is affected by losing one’s LAA. (In dogs, the LAA provides 17.2% of the volume of blood pumped by the left atrium.)
If you are an active exerciser or athlete, you may want to consider keeping your LAA if possible. But for most people, losing your LAA probably won’t affect you very much. You may not even notice your LAA is gone.

What this Means to Me: A Watchman in my Future

Personally, I love to run, do sprints, etc. But after two recent ablations (after 21 years of being A-Fib free), my Medtronic Reveal LINQ loop recorder recently picked up a full day of Silent A-Fib signals. (Reports are sent wirelessly to my EP each night by the bedside transmitter.)

This wasn’t a big surprise. In my last ablation, my LAA was ablated to stop A-Fib signals, but it also electrically affected the LAA from pumping out properly. My EPs warned me that I would likely need to close-off my LAA sometime in the future.

With this recent data, my two EPs (Drs. Doshi and Natale) recommended I close-off my LAA with a Watchman device.

Even though it might affect my pumping ability, at age 81, stopping my A-Fib signals is more important to me. After my Watchman implant, I’ll write more. 

For my first-hand account of having a Medtronic Reveal LINQ loop recorder, go to Has My A-Fib Returned? I Get an Insertable Wireless Monitor

Reference
Heuts, S. et al. Does Left Atrial Appendage Exclusion by an Epicardial Clip influence Left Atrial Hemodynamics? Pilot Results of Invasive Intra-Cardiac Measurements. JAFIB Journal of Atrial Fibrillation. http://www.jafib.com/PMC/XML/Inprogress/FullIssue/2021-06-30.pdf#page=64

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