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Can anyone recommend a procedure to deal with a thrombus in the LAA?
I have had persistent afib for 8 months. I have had 4 TEE's, with a LAA thrombus found every time, hence no cardioversion or any other procedure. We have tried Dabigatran, and Eliquis to dissolve the clot. I have found a EP who will do the Watchman Procedure with a thrombus in place, but there is a risk that the thrombus could be dislodged. Does anyone know of other procedures that might be better suited to take care of a thrombus in the LAA - Wolf Mini Maze, Articlip, Hybrid?
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Hello @keepthebeat, welcome to Mayo Clinic Connect. If you haven't already, this article may shed some light on potential treatment options, although the article may not be a perfect match in every way since heart conditions can be so complex:
"Treatment of Persistent Left Atrial Appendage Thrombus in Patients with Atrial Fibrillation on Adequate Oral Anticoagulation: Pathways of Care for All-comers and Heart Failure Patients
" - https://pmc.ncbi.nlm.nih.gov/articles/PMC10311400/.
@rbc and @heartwarming have discussed the Mini Maze procedure and may be able to shed some light on that.
@keepthebeat, have you discussed your concerns about dislodgement with your provider? Or talked about alternative treatments, or is a Watchmen what they have definitively recommended?
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4 ReactionsThanks Justin.
Yes, I have seen this article.
My current provider has established a (in my opinion) really good program for afib. That is, if there are no contradictions. To put it another way, they cherry pick their patients. It's my perception that if a patient has pre existing conditions, they are very hesitant to do any procedures. Consequently, they have a very good success rate. In my case, anti coags are the only option, and to date they are not working. Which prompted me to get a 2nd opinion from an out of state EP, who I know does Watchman procedures with a thrombus in the LAA.
I am waiting to hear back from the team re my last TEE, which showed a thrombus still in place. They will probably go the Warfarin route with an ini of 2.5 - 3.5.
My 2nd opinion EP scheduled me for a Watchman procedure, but I am now wondering if perhaps a clip, or lasso might be a better choice in my instance - less chance of disturbing the clot?
I have been trying to talk with several institutions who do the other procedures, but it is a battle.
Part of the battle is the fact that I am in such a small minority.
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1 ReactionI may be laboring under a misapprehension, but I thought that Heparin was at least somewhat decent at dissolving thrombi. But, it's tricky stuff, and would have to be administered under strict supervision by medical staff.
If you don't mind consulting a bit more widely, Dr. Andrea Natale at the Texas Cardiac Arrhythmia Institute in Austin is a world class electrophysiologist who is approachable, if busy. He, or his nurse, might be willing to offer you some information or referrals to a place where they deal with intractable thrombi.
It's a thought...
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2 ReactionsMy brother self administered heparin for a few weeks after discharge from multiple PEs that by all rights should have killed him. He ignored Afib symptoms which lead to PEs and ignored chest pain symptoms. He was 100#s overweight at the time. Afterward he became a believer and lost all the weight and now walks and lifts weigh at 81.
Wow, good for him. Nuthin' like a will to live. 😀
I have Bradycardia, presumably from thyroid issues and my adrenal gland function being on the ground. &Hoshimoto Syndrome. So, how can I get my heart rate above 45.
Since you appear to have a formal diagnosis (??), I would assume that you are on a monitored rate of Synthroid or some other suitable remedy?
Your HR should....SHOULD...rise to a utile level based on your level of exertion and oxygen debt/CO2 levels (hypercapnia). If you are precluded from any useful exertion, say wheeling some sod away from a place you are clearing in your yard, then you may need further assessment, and possibly a modest rise in your prescribed thyroxin substitute. That's just a guess...I'm not an endocrinologist.
I don't know anything about adrenal insufficiency. I have heard of overactive adrenal glands, which is a whole 'nuther issue.
Finally, I happen to think, and it's just me based on a lot of reading and listening to cardiologists over the seven years I have had atrial fibrillation (AF), but a resting HR of 45 is NOT a problem. It just isn't. Down to 30-35, yes, and get help soon...but 45 for an otherwise healthy and resting heart is nothing to be concerned about. It's when you want to impose a rising demand on your heart, and cannot...there is where you should actively pursue the matter and get it dealt with. My opinion, strictly.