Do you know there are approximately 0,4%-1% people who suffer from atrial fibrillation in Indonesia?¹ It may not seem like it, but the percentage is considered high for the overall public health measurement. People who are older than 60 are also known to suffer from atrial fibrillation easier than the other age group.

That being said, the knowledge regarding atrial fibrillation is not yet spread evenly. So, what really is atrial fibrillation? Atrial fibrillation, also known as Afib, is a heart condition that belongs to the arrhythmic group.

How to Diagnose Atrial Fibrillation?

Diagnose Afib

Your medical team can say that you have atrial fibrillation if they have done these tests:⁶

  1. Blood test: Done to make sure whether there is something else that influences the heart rhythm. Although there are many, your medical team may do a Complete Blood Count (CBC) blood test. From CBC, they will know your hemoglobin percentage and if there is a bleeding possibility.

  2. Elektrokardiogram (EKG): This test is done to evaluate your heart rhythm. EKG is the main test to diagnose atrial fibrillation.

  3. Holter monitor: An EKG device for long term usage, 24 hours to 2 weeks. You can do your daily activities while wearing this device.

  4. Event recorder: Similar to the holter monitor, the difference is that the event recorder will only record during certain times. You will wear this device for 30 days or until an abnormal heart rhythm occurs. 

  5. Implantable loop recorder (ILR): Is an implanted device that will record your heart rhythm for 3 years. The point of this device is to monitor your heart during daily activities and to detect the frequency of an Afib episode.

  6. Echocardiogram (ECG): Cardiac ultrasound examination that focuses on the possibility of structural and functional abnormalities on the heart. For example, leaky valves.

  7. Transesophageal echocardiography (TEE): A more accurate type of cardiac ultrasound, used to  assess structural abnormalities and to detect the presence of blood clots in the left atrium. The presence of blood clot in the left atrium is a major risk factor for stroke in patients with atrial fibrillation.

  8. Exercise Stress Test: Done to see how the heart responds to physical activity, commonly done using treadmill or stationary bike. If a patient is unable to exercise, they can be given medicines that portray the effect of exercise; sometimes also combined with echocardiogram.

What is the Connection Between Atrial Fibrillation and Stroke?

afib and stroke relation

Do you know that atrial fibrillation patients have a higher risk of stroke?² The reason behind this is during atrial fibrillation (AFib), the upper chambers of the heart (atria) beat irregularly, causing what should be smooth blood flow to become turbulent. A turbulence happening in the heart’s blood flow is one of the risk factors of a blood clot forming in the heart, especially in the left atrial appendage. These accumulated blood clots, if they break free from the heart chamber and enter the systemic circulation, can result in a stroke. 

How to Prevent Stroke on Atrial Fibrillation Patients?

So, is there a way for patients with Afib to prevent stroke? Don’t worry, there certainly is! Take a look at the information below:²

 1. Blood Thinning Medications

The first thing you can do is consume blood thinning medications. Blood thinning medications have been proven to be an effective solution to reduce stroke risk on Afib patients. However, the use of blood-thinning medications must always be under a doctor’s supervision due to the risk of bleeding associated with these drugs.

2. Left Atrial Appendage Closure

For patients who are unable to consume blood thinning medications due to their medical history (e.g. bleeding from consuming blood thinning medications), they need another alternative. Left atrial appendage closure is one of the options to reduce stroke occurring in Afib patients. Left atrial appendage (LAA) closure is a minimally invasive procedure. In this procedure, your left atrial appendage will be closed permanently.

When is the Best Time to do LAA Closure?

Then, when is the best time to do LAA closure? Generally, this procedure fits best for Afib patients who are at high risk of stroke but is unideal for consuming blood thinning medicines in the long term. 

LAA Closure Procedure

laa procedure

I. Pre-operation Preparation

Before undergoing surgery, patients need to undergo several examinations, such as an echocardiogram, TEE, and a CT scan of the left atrium. These tests will give your medical team complete information regarding your heart condition, including the shape of the left atrial appendage and the presence or absence of blood clots in the left atrium or left atrial appendage. Next, you also need to fast for 6 hours before the surgery because during the surgery, you will be sedated by the anesthesia team.³

II. LAA Closure Procedure

During the procedure, a cardiologist will use a catheter to insert a device that will close the left atrial appendage. The following are the steps of the left atrial appendage closure (LAA closure) procedure:²

  1. You will be sedated by the anesthesia team, so during the procedure you will be asleep.

  2. TEE will be done again to confirm your heart appendage’s condition, structure, and size.

  3. The doctor will then insert a catheter into a blood vessel through the vein in your right groin.

  4. Based on the imaging obtained, the doctor will determine the appropriate device size for you.

  5. After that, the device will be positioned at the opening of the left atrial appendage to seal it.

  6. Finally, the doctor will remove the catheter.

This left atrial appendage closure procedure can significantly reduce the risk of stroke. This is because approximately 90% of strokes originating from the atria come from the left atrial appendage. 

What Happens After LAA Closure Procedure?

After the surgery, the patient will be taken care of in the hospital for a few days, below is the full information:³

  1. Hospitalized for 1–2 days or more for observation.

  2. The patient will undergo a follow-up echocardiogram 48 hours after the procedure.

Will There Be Any Side Effects?

Like any other procedure, LAA closure also has side effects that could happen. These side effects are divided into 2 categories, side effects caused by the device and caused by the procedure. Here are some of the side effects and the percentage of them happening:⁵

  1. Side Effects Caused by the Device

    a. Device embolization, 0,6%⁹

    b. Peridevice leak, 1%¹⁰

    c. Pericardial effusion, 4,6%⁹

  2. Side Effects Caused by the Procedure

    a. Groin hematoma, 1%⁷

    b. Femoral arterial pseudoaneurysm, 0,5%⁸

    c. Femoral arteriovenous fistula, 0,2%⁸

    d. Retroperitoneal bleed, 0,1%⁸        

Nevertheless, with current advances in medical technology, the risk of such side effects is relatively low.

What Should You Do If Side Effects Occur?

So, what should you do if signs of side effects appear after you have returned home? Immediately contact the medical team or go to the hospital if any signs of side effects occur. Don’t worry, even after discharge, the hospital will continue to monitor your condition.

You will need to attend regular follow-up visits at the hospital 45 days, 4–6 months, and 12 months after the procedure.¹¹ This is important so the medical team has complete information about your condition at home and after the surgery.

Routine Follow-up Schedule After LAA Closure

laa closure follow up sechedule

Reference

  1. Yuniadi, Y., Adhantoro, R., & Munawar, M. (2007). Ablasi Frekuensi Radio Pada Fibrilasi Atrium Paroksismal20. Jurnal Kardiologi Indonesia, 28(5), 1.

  2. https://www.bostonscientific.com/content/dam/bostonscientific/Rhythm%20Management/portfolio-group/WATCHMAN/BSH081518_Watchman_DTP_Patient_Brochure_DINSH0131EA_72dpi.pdf

  3. https://my.clevelandclinic.org/health/treatments/17167-left-atrial-appendage--closure

  4. Verma, S., Bhatt, D. L., & Tseng, E. E. (2021). Time to Remove the Left Atrial Appendage at Surgery: LAAOS III in Perspective. AHA Journals, 144(14), 1088–1090. https://doi.org/10.1161/circulationaha.121.055825

  5. Perrotta, L., Dugo, D., & Fürnkranz, A. (2014). Complications From Left Atrial Appendage Exclusion Devices. PubMed, 7(1), 1034–1034. https://doi.org/10.4022/jafib.1034

  6. https://www.mayoclinic.org/diseases-conditions/heart-arrhythmia/symptoms-causes/syc-20350668

  7. Alzahrani, A., Wazni, O. M., & Hussein, A. (2024). Outcomes of Concomitant Atrial Fibrillation Ablation and Left Atrial Appendage Closure: A Retrospective Single-Center Experience. JACC: Advances, 3(12), 101377. https://doi.org/10.1016/j.jacadv.2024.101377

  8. Bhatty, S., Cooke, R., & Shetty, R. (2023). Femoral vascular access-site complications in the cardiac catheterization laboratory: diagnosis and management. Interventional Cardiology, 3(4), 503–514. https://www.openaccessjournals.com/articles/femoral-vascular-accesssite-complications-in-the-cardiac-catheterization-laboratory-diagnosis-and-management.html

  9. Nakamura, M., & Nagasaka, T. (2023). Left Atrial Appendage Closure: A Narrative Review. Cardiology and Therapy, 12(4), 615–635. https://doi.org/10.1007/s40119-023-00337-2

  10. Saw, J., & Holmes, D. R. (2023). SCAI/HRS Expert Consensus Statement on Transcatheter Left Atrial Appendage Closure. Journal of the Society for Cardiovascular Angiography & Interventions, 2(3), 100577–100577. https://doi.org/10.1016/j.jscai.2022.100577

  11. https://www.watchman.com/en-us/resources/articles/watchman-device/after-procedure-left-atrial-appendage-closure.html