New Device Reduces Risk of Stroke in Patients with Atrial Fibrillation

Boca Raton Community Hospital announced this week that it is now one of only a handful of facilities in the US to use the AtriClip, a “recently FDA-approved device to exclude the left atrial appendage, a site associated with stroke in atrial fibrillation (afib) patients.”

A news release from the hospital notes that the Framingham Heart Study and other trials have shown that patients with atrial fibrillation face a five times greater risk of stroke than patients who don’t have the condition. The increased risk of stroke during atrial fibrillation is due to blood collecting in the “irregular interior surfaces called trabeculations” of the left atrial appendage (LAA) in the left atrium of the heart, forming clots that “migrate through the circulatory system, block circulation to key structures in the body and lead to stroke.”

According to the news release, surgeons used to staple the LAA or suture it shut, procedures that were successful only 40% of the time. Now, with the AtriClip, surgeons can use a minimally invasive (or “keyhole”) technique to insert the device and clamp off the blood flow between the LAA and left atrium, enabling the body to reabsorb the LAA over time. The FDA approved the AtriClip for stroke prevention in patients with afib in June 2010.

James Morris, MD, medical director of the Boca Raton Community Hospital Christine E. Lynn Heart and Vascular Institute (LHVI), said that up to 90% of clots form in the left atrial appendage, and that “by occluding, or cutting off blood flow into the LAA, we can dramatically reduce the chance of stroke for patients with afib.” Morris also said that “the logic behind the AtriClip is quite elegant. If the LAA presents all risk but no reward to the afib patient, why not simply eliminate it?”

Although one potential benefit of using the AtriClip is that it can alleviate the need for some patients to take Coumadin and other anticoagulation medications, this applies only to patients who have afib and does not replace the need for anticoagulant therapy in patients with deep vein thrombosis or for use in patients post-angioplasty. Morris said that although the benefits of the AtriClip procedure are encouraging, “it is essential that the public knows the therapy is applicable only to patients with atrial fibrillation and high risk for stroke,”

More on the AtriClip:

In June 2010, the FDA approved the AtriClip Gillinov-Cosgrove Left Atrial Appendage Exclusion system for stroke prevention in atrial fibrillation patients undergoing open heart surgery.

Videos, product specs, and more from AtriCure, the maker of the AtriClip Gillinov-Cosgrove LAA Exclusion System

Exclusion of the Left Atrial Appendage with the AtriClip LAA Exclusion Device in Patients Undergoing Concomitant Cardiac Surgery (an ongoing, but not actively recruiting clinical trial)

The StopAfib Atrial Fibrillation Blog notes that “the AtriClip isn’t limited just to afib surgery. Just last week, Dr. Mubashir Mumtaz, Chief of Cardiovascular and Thoracic Surgery at Pinnacle Health in Harrisburg, PA, implanted the AtriClip in a patient who was having her mitral valve replaced.”

Study: Success of Surgical Left Atrial Appendage Closure: Assessment by Transesophageal Echocardiography