Lariat Procedure

New Procedure helps Prevent Stroke in "A-Fib" Patients Who Can't Use Blood Thinners

The debilitating effects of stroke often last long after the first signs appear; a survivor may face months—sometimes years—of rehabilitation to relearn basic skills that were lost. So when some patients learn that the blood thinner they’re taking to help avoid a stroke may be causing more harm to their bodies, it can be terrifying.

Patients with atrial fibrillation, or“A-fib,” have hearts that beat irregularly and too fast. Nearly 3 million Americans have A-fib, and because the condition makes it harder for the heart’s upper and lower chambers to stay in sync, there’s a higher chance of stroke-causing blood clots forming. Stroke is the third-leading cause of death in the United States. Anticoagulant medications like warfarin, rivaroxaban, apixaban or dabigatran can be prescribed to reduce the risk of stroke, but they expose patients to an increased bleeding risk and require frequent blood tests, monitoring and doctor visits.

“We estimate that 20 percent of elderly A-fib patients cannot use blood thinners because of a history of gastrointestinal bleeding or other complications, so they are unprotected against stroke,” says Mukta Srivastava, MD, an interventional cardiologist and an assistant professor of medicine at the University of Maryland School of Medicine. “For older adults, loss of independence is their biggest fear, so the possibility of stroke is unsettling.”

Being the First

For these patients, a new treatment option could prevent stroke without causing other health issues in the process. University of Maryland Medical Center is one of only a few hospitals in the mid-Atlantic region to begin using a groundbreaking procedure called Lariat, which ties off a clot-forming portion of the heart in A-fib patients, sparing them the need to take blood thinners and lowering their stroke risk.

For A-fib patients with a history of complications from taking anticoagulants, the Lariat procedure is a strong alternative to decreasing the risk of stroke without affecting the rest of the heart.

“There is a section of the heart called the left atrial appendage that’s much like the appendix in that we can live without it, but it can also be problematic as a source of stroke,” explains electrophysiologist Vincent See, MD, an assistant professor of medicine at the University of Maryland School of Medicine. “But research indicates that 80 to 90 percent of blood clots that create an issue like stroke for A-fib patients may originate there.” Physicians haven’t found a significant clinical impact of removing the left atrial appendage from circulation.

During the procedure, the tiny Lariat device, which is similar to a cowboy’s lasso, is looped around the base of the left atrial appendage and tightened, permanently sealing it off from the rest of the heart and blocking any blood clots that form there from traveling to the brain. The procedure is performed under general anesthesia using two catheters, and is completed by a team of physicians from interventional cardiology, cardiac electrophysiology, cardiology, cardio thoracic surgery and anesthesiology.

“This procedure offers an alternative for stroke protection,” Dr. See says. “It’s minimally invasive but also technically advanced.” Before the Lariat procedure, tying off atrial appendages required open heart surgery.

Hope on the Horizon

Since it was approved by the Food and Drug Administration in 2008, Lariat has been used in an estimated 1,400 A-fib patients in the United States and Poland. There are two other devices under development that seal off the left atrial appendage, so a greater array of solutions for this problem is on the horizon.

University of Maryland Medical Center performed its first Lariat procedure on a patient last August; that patient recovered completely and is back to her normal activities. “Most patients won’t feel differently after the procedure, but they will have greater peace of mind knowing that they have added protection against stroke. It is something we are excited to offer to our patients,” Dr. Srivastava says.

Learn more about Lariat

To discover more about the Lariat procedure at University of Maryland Medical Center, call 1-866-408-6885.

This page was last updated: August 26, 2014

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