Dallas hospital offers new procedure to prevent strokes in atrial fibrillation patients

DALLAS, Sept. 5, 2012 /PRNewswire-USNewswire/ -- For Freida Lewis, a simple fall almost turned deadly.

(Photo: http://photos.prnewswire.com/prnh/20120905/DC67522)

Like many people with atrial fibrillation, the most common type of heart rhythm disorder, Lewis was on blood thinners to prevent a stroke. When in atrial fibrillation, the upper chambers of the heart no longer contract. This allows blood to pool in the left atrial appendage.

"The appendage is excess tissue that does not impact heart function in afib," said Dr. Brian Le, director of cardiac electrophysiology at Texas Health Presbyterian Hospital Dallas. "But if a-fib causes the appendage to stop contracting with the rest of the heart, blood inside the appendage becomes thick and gel-like.  This can lead to a blood clot that breaks free and travels to the brain, causing a stroke."

Dr. Le is the first physician in the North Texas region to perform a new type of minimally invasive procedure to prevent strokes in patients with atrial fibrillation, which affects three million Americans annually. The procedure, called the Lariat, involves tying off the appendage, which is responsible for 90 percent of strokes in a-fib patients.

To tie off the left atrial appendage, Dr. Le makes a tiny incision in the patient's leg vein, then inserts a tiny wire into the vein and guides it into the heart. He then places a 3.5 millimeter access in the sack surrounding the heart (called the pericardium) and guides the wire to the outer atrial appendage.

Guide wires with magnets then connect inside and outside the appendage to form a rail. From the pericardium, a tiny device called the Lariat, which is an expandable loop of suture, follows the magnetic wire rail to the appendage. Using X-ray and ultrasound imaging, Dr. Le lassos the suture loop over the neck of the appendage. He then gently tightens the lasso and the appendage is cut off from circulation inside the heart, eliminating it as a source of blood clots that can travel to the brain.

"This is the best of modern medicine," he said. "We're applying technology and advances in patient care to prevent serious problems for a large number of patients."

Patients with atrial fibrillation who are at high risk for a stroke are advised to take blood thinners for life to reduce the risk of debilitating strokes. But some can't take blood thinners due to concomitant high risk of bleeding.

Therefore, patients remain unprotected from the risk of strokes when they are in a-fib.

"Now we have a way to improve the lives of patients who fall into this category through a minimally invasive procedure. Prior to the Lariat, the only way to tie off the appendage was by open heart surgery," Dr. Le said. "Once the procedure is performed, patients no longer require blood thinners from that day forward."

Freida Lewis was on blood thinners when she fell in her alley while taking the trash out. A tiny scrape bled for hours. Another fall not long after the first convinced her something had to be done.

"I just couldn't go through life worried about getting a tiny cut, but I also didn't want the risk of having a stroke. Today, I'm grateful I had the procedure. It's been a Godsend. I'm back to being active and working in my garden and doing all the things I used to do."

SOURCE Texas Health Resources

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