Stroke Risk and LAA Occlusion

I still post regularly on AF support forums giving updates on my progress; mainly the AF section of health unlocked https://healthunlocked.com/.  I think this is helpful to new sufferers, as most posts on there are about problems rather than solutions, possibly because “cured” members tend to drift away. I think it is also useful as my treatment is relatively rare in the UK; mini-maze with Left Atrial Appendage Occlusion by the Atriclip device.

Occasionally, I will be admonished by other members of the forum for not remaining on anticoagulants; the feeling is that the risk of stroke continues after NSR is returned and that there are possibly times when I could be in AF without realising it.

Today I found a reassuring video of a PPT presentation by Michael Hoskins of Emory University Hospital. https://wondrmedical.net/videos/Atrial-Fibrillation-Therapies-38BC74612

The presentation discussed a couple of medical trials: ProtectAF and Prevail.  Protect was to look at how the outcomes of LAAO compared with Warfarin.  Initially ProtectAF showed that post procedure stroke prevention was as good as warfarin, but there were issues with complications.  Prevail was designed to examine the safety aspects of LAAO after the original issues with ProtectAF came to light.  This research and the later entrants to protectAF showed that these had been resolved as surgical experience improved. 

The data after five years showed that LAAO was not inferior to warfarin for ischemic stroke, although there was a slight inferiority visible on the graph.  Importantly, it did show a great advantage with regard to haemorrhagic stroke and a large reduction in all case mortality.  A secondary finding was that ablations with LAAO were more effective and less likely to revert. LAAO has always been controversial, some cardiologists believing that it may have an as yet unknown function, this report concludes that the existence of the LAA contributes to the chances of developing AF.

Overall, this study gives me confidence that I made the correct choice and am happy to continue my drug free life.

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