MDNews - Cleveland-Akron-Canton

Cover Feature quality of the closure, a companion device to the Lariat is used. "To pull the suture tight, we use a system that provides a consistent amount of pressure — 5 pounds of pressure applied for five seconds — so it's very precise. I think that's part of why the closure rate is so good — 95 percent —because the system is so exact," says Dr. Ziv. "The good thing is that the suture is delivered from outside the heart. As a result, there's nothing in the heart that can get into the bloodstream or that can embolize. And there are no plugs or other occlusion devices left behind in the LAA that can erode or cause other problems." Also, unlike other atrial occlusion procedures, the Lariat does not require temporary anticoagulation before or after the procedure. Patient Selection Patients who qualify for the procedure are those with atrial fibrillation who have: + CHADS2 score of 2 or greater or any two risk factors such as hypertension, diabetes, advanced age, congestive heart failure or a prior stroke or TIA + A contraindication to anticoagulation + No prior open heart surgery + No adva nced k idney disea se/ renal insufficiency. To date, three patients at MetroHealth have undergone the Lariat procedure, and two more have been scheduled for it. In the three patients, the appendage was successfully closed with no residual opening. (This was verified 30 days post-procedure 12 | Cleveland/Akron/Canton MD News with echocardiography.) All three are taking aspirin or Plavix as a prophylaxis. "We've had to turn away about 30 percent of those referred to us," says Dr. Ziv. "Some because their atrial appendage was positioned beneath the pulmonary artery and could not be easily accessed, and others because their LAAs were greater than the diameter of the Lariat, which is 4 cm. (A larger-diameter Lariat is currently being designed.) Obviously, we are very careful about patient selection." Right now Dr. Ziv is performing the Lariat procedure with FDA approval for patients with AFib who have a high risk for stroke and cannot take anticoagulants. As for the future, he predicts the question ■ mdNEWS.Com ■ NovEmBEr /dECEmBEr will be: Does the lariat do a good enough job of reducing stroke that even those who can take anticoagulants would be better off with the Lariat? "That underlying 1.2 percent risk of major bleeding that everyone has with blood thinners — is that enough to tip the balance so that you're really better off with the Lariat? If clinical studies show that, then really the way we think about atrial fibrillation and stroke prevention will be completely different," he says. "That will be very interesting. That will be the really important question for the future." For more infor mation about the MetroHealth Atrial Fibrillation Center, visit www.metrohealth.org/heart. To refer a patient, call 216-778-BEAT (2328). ■

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