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Texas Health Dallas is First in North Texas to Offer Lariat Atrial Fibrillation Procedure
08/29/2012

DALLAS — For Freida Lewis, a simple fall almost turned deadly.

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 and a physician on the medical staff at Texas Health 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 break free and travel to the brain, causing a stroke.”

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.

“The appendage is an out-pouching in the left atrium that is responsible for 90 percent of strokes in patients with atrial fibrillation,” Le said.

To tie off the left atrial appendage, 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, 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,” Le said. “We’re applying technology and advances in patient care to prevent serious problems for a large number of patients.”

Blood clots that break loose from the atrial appendage can also travel to the kidneys and other vital organs, causing permanent disability or death.

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 people with a-fib are not candidates for blood thinners due to concomitant high risk of bleeding on blood thinner.

Therefore, patients remain unprotected from the risk of strokes when they are in a-fib. The Lariat procedure fills this void to reduce the risk of a stroke in a-fib without requiring blood thinners.

“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,” Le said. “Once the procedure is performed, patients no longer require blood thinners from that day forward.”

Lewis was on blood thinners when she fell in her alley while taking the trash out earlier this year. A tiny scrape on her arm bled for hours. “It was really scary,” she recalled. “It was the first time I felt like I couldn’t live on blood thinners any longer.”

Another fall not long after the first convinced her and Le that something had to be done to get her off blood thinners without the risk of stroke.

“That’s when we decided it made since to consider the Lariat procedure,” she said. “I just couldn’t go through life worried about getting a tiny cut or scrape, 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.”

About Texas Health Presbyterian Hospital Dallas
Texas Health Presbyterian Hospital Dallas is an 898-bed acute care hospital and recognized clinical program leader, having provided compassionate care to the residents of Dallas and surrounding communities since 1966. U.S. News and World Report has ranked Texas Health Dallas among the nation’s best hospitals in digestive disorders, orthopedics, and neurology and neurosurgery. An affiliate of the faith-based, nonprofit Texas Health Resources system, Texas Health Dallas has approximately 4,000 employees and an active medical staff of more than 1,000 physicians. For more information, call 1-877-THR-WELL, or visit TexasHealth.org/Dallas.

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