A minimally invasive procedure that combines ligation of the left atrial appendage (LAA) with hybrid epicardial-endocardial ablation is a feasible, safe and effective method of treating patients with longstanding atrial fibrillation (AF or AFib), according to a new Vanderbilt-led study.
The study, published in the Journal of American Cardiology: Clinical Electrophysiology, demonstrates a promising new approach to allow AFib patients to discontinue blood thinners and, in many cases, heart rhythm medications, said lead author Christopher Ellis, MD, associate professor of Medicine in the Vanderbilt Heart and Vascular Institute (VHVI).
AFib is the most common kind of cardiac arrhythmia, affecting more than 5 million Americans. The heart condition occurs when the upper chambers of the heart beat too quickly, resulting in irregular rhythm and a higher risk for blood clots that cause strokes.
The study followed 33 patients who successfully underwent the hybrid procedure, who reported no long-term complications, strokes or deaths. Most were able to be removed from blood thinners, Ellis said. Future prospective studies are needed to validate the initial findings, according to the study.
“This study really is born from nearly a decade of experience of doing complex hybrid AFib procedures,” Ellis said. “It’s almost a uniquely Vanderbilt-driven treatment strategy in combination with a handful of sites across the country. At least preliminarily, it looks like a nice way to treat a traditionally difficult-to-treat population.”
Ellis noted that a cure for AFib has not been discovered, but this appears to be the most robust, minimally invasive approach to date. The procedure studied begins with one small, 3-4 cm incision under the xyphoid, or sternum. An LAA closure device called the Lariat is used to eliminate blood flow into the left atrial appendage, to prevent strokes and improve chances of staying in rhythm. Then, an extensive ablation inside and outside the heart is completed. Most patients return home two to three days following the procedure.
“This is the first series of these patients that has ever been reported,” Ellis said. “All of these were longstanding AFib patients with large dilated atria, very challenging patients.”
Ellis said the procedure is particularly useful for patients who have experienced AFib for an extended time. He noted that VHVI is one of only a handful of centers in the country with the capability to perform a hybrid procedure with the Lariat and this surgical technique.
The standard treatment for AFib has been some combination of invasive surgical approaches or prolonged prescription of blood thinners such as Eliquis or Xarelto, Ellis said, which have their own downsides.
The drugs are expensive and patients may be inconsistent in using them, which increases the risk of a stroke.
Patients also bruise easily and carry a significant risk for bleeding complications long term.
Ellis said the hybrid procedure allows most patients to drop blood thinners.
“For a lot of people, that is really appealing to them,” he said. “They want to get off as many medications as possible. And if you’re in persistent AFib, you’re probably on a lot of medicines.”
