AF Information & Advice For Patients
Lionel was diagnosed with AF in October 2007, and was fitted with a pacemaker in February the following year.
In November 2012, he received the left atrial appendage occlusion after suffering two transient ischemic strokes.
This is his account of the procedure.
I was taking a walk with my wife, as is normal for us on a Sunday morning. When we returned home, I found my speech was confused, and it was difficult to get words out. My wife, Elizabeth, called the doctor, who came over immediately, and called 999.
When I was looking at the doctor’s face, half of it appeared as though I was looking through a gauze. I was taken to Northwick Park Hospital A&E, where I was tested and told I had had a transient ischaemic attack (TIA), and sent home to return to the specialist stroke clinic the following day.
The next day I found it almost impossible to use the keyboard of the computer. At the stroke clinic I was again questioned, and tested. I had suffered a second TIA that morning. The medical practitioners did an ultrasound of my carotid artery, and said everything was fine. I was reassured that I was taking the right preventative medication. So, I was sent home and advised not to drive for a month.
Left atrial appendage occlusion
The following month I had a routine meeting, or I thought it would be, at the Clementine Churchill Hospital. I thought I was seeking advice from my cardiologist about shortness of breath. The consultant considered the TIAs I had the previous month, together with my previous medical history, and questioned whether I needed to have a left atrial appendage occlusion (LAAO).
This procedure involves inserting a catheter into the femoral artery from the groin, which is fed to the heart. An umbrella-shaped device is planted over the left atrial appendage, where blood clots are more likely to form in people with atrial fibrillation. The device blocks the left atrial appendage to stop blood clots escaping off to the brain. In the meeting, we agreed that this procedure would be the best way forward for me.
Whilst I was waiting for the date to be fixed, my apprehension grew. We went to see the cardiologist the week before, and he helped to put our minds at rest.
On the day
7.30 am - We arrived at London Bridge Hospital. I changed into the usual open backed hospital gown and there were checks and re-checks by nurses. Then the anaesthetist came to talk to me, and the cardiologist asked me to sign a consent form.
9 am - I was taken to a large gleaming operating theatre. There were eleven people in the theatre; three cardiologists (two for the LAAO, and one for the transesophageal echocardiogram; TOE), an anaesthetist, medical assistants, and other specialist nurses. A mask was slipped onto my face and seconds later I knew no more.
1 pm - I woke up in the recovery room, and was taken back to my hospital ward. Overall, the entire procedure had taken 4 hours.
The rest of the day is somewhat blurred. I was conscious but woozy. I had some slight discomfort from my back from time to time. I now know when one comes out of a general anaesthetic, it is normal to shiver and shake for a short period.
6 pm - The consultant came to see me and advised that all had gone well. That evening I was very tired, and after dinner, went to sleep almost immediately before 8pm.
Following day - I woke up early the next day. The doctor advised of various further tests, and we returned home by 1.00.pm. It felt like we had been away for two weeks, because so much had happened.
After the procedure
Two months after the procedure I returned to the hospital for a further TOE to check that the device had been placed correctly over the left atrial appendage in my heart. It was in perfect position!
Three month after the procedure, I was taken off warfarin which I had been taking for five years but was advised to take enteric-coated aspirin in the future.
From my experience I would recommend this procedure for any suitable AF patient who is at risk of stroke. I strongly believe information about LAAO should be widely available for both patients and even doctors.
Lionel, Elstree (2013)