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Question:

Is there a way for my mother to qualify for the Lariat procedure?

My mother has had non-valve related afib for many years and was treating it with low doses of Coumadin. In October, after suffering thunderclap headaches, she was diagnosed with Cerebral Amyloid Angiopathy, precluding any further use of blood thinners. We thought the Lariat Procedure was our saving grace, until a blood clot was found in the appendage. We have been advised that because of this, she is not a candidate for Lariat. What are your thoughts?

Submitted by Pam from Houston, Texas on 03/17/2014

Answer:
by William E. Cohn, MD

Pam, They are correct that the risks of using the Lariat in patients with clot in the left atrial appendage (LAA) are prohibitively high. Insertion of the magnet-wire and the endo-balloon (the components that are placed transiently inside the LAA to guide the suture into position) could dislodge clot, resulting in a stroke. I understand that with Cerebral Amyloid Angiopathy, blood thinners are contraindicated. Now that a clot has been identified in the LAA, perhaps the risks of a short interval (2-3 months?) of anticoagulation to allow the clot to reabsorb might be reconsidered in anticipation of a Lariat procedure if trans-esophageal echo demonstrates complete resolution. I hope this helps. Good luck.