Atrial fibrillation: sealing the heart
Luise Heine has been an editor at since 2012. The qualified biologist studied in Regensburg and Brisbane (Australia) and gained experience as a journalist in television, in the Ratgeber-Verlag and in a print magazine. In addition to her work at , she also writes for children, for example for the Stuttgarter Kinderzeitung, and has her own breakfast blog, “Kuchen zum Frühstück”.
More posts by Luise Heine All content is checked by medical journalists.MunichAtrial fibrillation can cause a stroke. This is because clots quickly form in the heart. To protect patients from such complications, doctors rely primarily on medicinal anticoagulants. But there is also a minimally intensive procedure that reduces the risk of blood clots.
The aim of such an operation is the so-called atrial appendage. In the case of atrial fibrillation, the blood quickly clumps in this small protuberance in the left atrium of the heart - and if the plug gets into the circulatory system, it can trigger a stroke. An endoscopic procedure protects against this: with the help of a catheter, the cardiologist can seal the atrial appendage with a closure system and thus prevent clots from forming.
How this form of stroke prevention compares to conventional anticoagulants was carried out by Prof. David Holmes from the Mayo Clinic College of Medicine (Minnesota) and his colleagues from various institutions.
Intervention better than medication?
To do this, they used data from over 700 patients with atrial fibrillation. In 463 of them the atrial appendage had been closed mechanically, 244 had taken the anticoagulant warfarin (vitamin K antagonist) for prophylaxis. For four years, the researchers followed the health status of the test subjects. In particular, the researchers were interested in strokes, thromboembolism, and cardiac or non-specific deaths that occurred among the participants.
The evaluation showed that the minimally invasive procedure was even superior to the drug in terms of clot protection. While 13.9 percent of the test subjects in the warfarin group experienced such problems, it was only 8.4 percent for the rest.This also had an impact on the mortality rate: this was 4.8 per 100 patient-years for all-cause mortality for warfarin compared to 3.2 for the operated group.
Stroke risk reduced by 70 percent
Atrial fibrillation is a special form of arrhythmia. It can - depending on the cause - occur regularly, seizures or for some time. Atrial fibrillation is one of the most common cardiac arrhythmias, especially in the elderly. Anticoagulants help reduce the resulting risk of stroke by up to 70 percent. However, they can only be taken in patients who do not suffer from an increased risk of bleeding - for example because they suffer from gastric ulcers or cancer.
Source: Vivek Y. Reddy et al. Percutaneous Left Atrial Appendage Closure vs Warfarin for Atrial Fibrillation; JAMA. 2014; 312: 1988-1998. doi: 10.1001 / jama.2014.15192
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