Left Atrial Appendage Occlusion
Commissioning LAAO in England
In 2012, a draft policy statement was issued by the Specialised National Commissioning Board (SNBC) to restrict the commissioning of a very important therapy for people unable to take oral anticoagulation - Left Atrial Appendage Occlusion (LAAO).
We asked for your support to campaign against this in February 2013. Following the high number of responses from patients, carers and healthcare professionals to their MP's and service providers, we were reassured by the SNBC that all responses received were included in the review of this statement.
In April 2013, NHS England published a clinical policy statement on LAAO that states the procedure will not be routinely funded, but will be assessed further through a ‘commissioning through evaluation’ process.
This will ensure further evidence is accumulated while a limited number of procedures are carried out at dedicated centres.
The AF Association is involved in helping to design this process and we are pressing to ensure not only is there equity of access, but also timely referral for consideration of the procedure.
Currently plans are only in draft, and we are awaiting a review by NHS England to confirm whether the proposals are approved. It is hoped that from October 2013, NHS England will re-instate commissioning, however both the date and the detail has yet to be confirmed.
What is the left atrial appendage occlusion (LAAO) procedure?
The LAAO device, in trials and in practice, has proven to be an effective option in reducing the risk of AF-related stroke in AF patients for whom an oral anticoagulant such as warfarin, dabigatran or rivaroxaban, is unsafe or contraindicated.
Atrial fibrillation (AF) can present in varying forms and with a range of symptoms. However, common to all of these is the increased risk to an individual of an AF-related stroke. AF-related strokes are far more likely to be disabling and fatal than non-AF strokes.
The AF Association, in partnership with NHS Improvement, is supporting an extensive educational programme seeking to increase the use of appropriate therapies for all AF patients in order to significantly reduce the risk of AF-related strokes.
- A left atrial appendage device protects, restores and gives hope for a future.
- LAA devices can reduce the risk of an AF-related stroke by up to 70%.
- It is needed because there is NO OTHER alternative available for this group of high risk AF patients.
How the procedure works
The procedure takes around 1-2 hours and the patient is usually given general anaesthetic. Depending on the type of imaging system used for visualising the heart, the procedure could be done under sedation.
A guide sheath (flexible tube) is inserted into a large vein in the groin and threaded up to the right atrium of the heart. It is then passed through a hole into the left atrium. In some patients this hole exists naturally; if not the doctor will make a small needle-hole and stretch it to allow the sheath through. The doctor then positions the guide sheath in the mouth of the left atrial appendage, and uses it to pass the occlusion device inside.When the doctor is satisfied with the position of the occlusion device, it is released, plugging the appendage, and the sheath is then removed
This video illustrates the procedure:
Centres commissioned to offer LAAO procedure:
• The Newcastle upon Tyne Hospital NHS Foundation Trust
• South Tees Hospitals NHS Foundation Trust
• Liverpool Heart & Chest Hospital NHS Foundation Trust
• Leeds Teaching Hospitals NHS Trust
Watch videos of patients who have benefitted from a LAAO:
Further information for healthcare professionals