Search our website Find job opportunies at THI and St. Luke's Find a doctor location and contact information
Heart Information Center
 
Ask a Heart Doctor
  Back to previous page

 

Help us improve this service.

Your feedback will help guide us in developing this site.

Ask a Texas Heart Institute Doctor 
Informed patients make better patients.

Question:

Should I have the Lariat procedure or Watchman device?

I am 62 years of age, in relatively good health except that I am in constant afib. Approximately 2 years ago I suffered a stroke (not a TIA) but fortunately have had no apparent after effects. I was placed on Pradaxa. I was regularly exercising however my heart rate under strenuous exercise could reach about 220 (prior to my stroke my max HR was about 178). About 7-8 weeks ago I suffered a splenic infarction (my doctors were quite surprised since I was on anticoagulation medication). I was switched to Xaralto and a baby aspirin and advised to stop "strenuous exercise" (I first noticed discomfort from the clot while doing sit ups). I had a complete blood work-up which came back normal. My doctors are recommending the Lariat procedure (actually they had wanted to implant the Watchman device but FDA has delayed approval). Could you offer any recommendation or opinion? Thank you.

submitted by David from New York on 7/2/2014

Answer:

William E. Cohn, MDby Texas Heart Institute cardiovascular surgeon, William E. Cohn, MD  

Hi David. First, let me be clear. I have a vested interest in SentreHeart and the Lariat, as I invented the technology and started the company. That said, I know the device intimately and I think I can offer you advice.  

The fact that you have had an embolic event while on anticoagulants suggests strongly that something should be done with respect to your atrial fibrillation and/or your left atrial appendage (LAA). Although there has not yet been a prospective randomized study looking at stroke and embolic prevention after the Lariat procedure, we are very certain that it is a safe and effective way to close the appendage. It is widely believed that most, if not all, emboli that patients with atrial fibrillation suffer (absent co-existent mitral valve disease) come from the LAA. The Lariat procedure has been performed in approximately 3000 cases. The main complication after Lariat is pericarditis and effusion, although 1% of patients have required urgent surgery after the procedure to repair a puncture to the right ventricle sustained during access of the space between the heart and the heart sack. The main difference between the Watchman and the Lariat is that the Watchman is a metal and fabric implant placed inside the heart, blocking the opening to the appendage. The Lariat on the other hand occludes the appendage by tying off the base of the LAA from outside the heart. I would recommend that you have your LAA addressed by one of these techniques. Conversely, some surgeons will staple or clip the appendage through a small 2-3 inch incision between the left ribs. It also may be a good idea to consult an electrophysiologist (if you haven't already... you probably have) to see if you are a candidate for an ablation of some sort, either catheter-based or surgical, to see if your atrial fibrillation can be converted to sinus (normal) rhythm. Good luck! Billy   

See also on this site:

Has your question or a similar one already been answered?
Search all the Heart Doctor questions and answers.

To search for a doctor or access St. Luke's physician referral service, use the "Find a Doctor" link at the top of this page.


Updated July 2014
Top  
Like us on Facebook Follow us on Twitter Subscribe to us on YouTube Find Us on Flicikr Follow Us on Pinterest Add us on Google+ Find us on LinkedIn

Please contact our Webmaster with questions or comments.
Terms of Use and Privacy Policy
© Copyright 1996-2014 Texas Heart Institute.
All rights reserved.
This website is accredited by Health On the Net Foundation. Click to verify. U.S. NEWS America's Best Hospitals 2013-14