Rhode Island Hospital’s David O. Williams, MD, recently performed a groundbreaking cardiac procedure designed to prevent stroke from atrial fibrillation. Williams, a pioneer in the field of interventional cardiology, inserted a tiny, collapsible cage, an “occluder,” into a portion of a patient’s heart on May 9, isolating it and preventing dangerous blood clots from forming there.
Part of a national clinical trial, it was the first such procedure performed in the Northeast. The operation appears to have been very successful, according to a Lifespan press release. The patient, a 56-year-old male, was discharged the following day.
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The device was implanted in a region of the heart called the left atrial appendage (LAA). Although the LAA has no known beneficial function, blood clots arising there are a major cause of stroke. For this reason, the LAA has been described as a “potentially lethal yet useless attachment.”
The clots often form there when atrial fibrillation (AF) is present. This abnormal heart rhythm affects more than two million people annually. Cardiologists will customarily place such patients on Coumadin, a powerful blood thinner that is effective in preventing clotting.
However, some people simply cannot take Coumadin because the drug causes them to bleed internally. For others, the complex dosing schedule is very difficult to follow, as is the frequent blood testing required. These patients with atrial fibrillation who cannot receive Coumadin are at high risk for strokes.
It is only such high-risk patients who are currently eligible for the trial procedure performed by Williams. Implantation of the left atrial appendage occluder is a non-surgical procedure. The device is inserted via catheter through a small incision in the groin.
Previously, the procedure had been performed nine times in the United States; in Seattle, Atlanta and Kansas City. Other sites participating in the trial are Emory University Hospital, the Swedish Heart Institute in Seattle, and St. Luke’s Hospital in Kansas City. Up to 30 more patients have been successfully undergone the procedure internationally.
The LAA occluder shows great promise according to Williams. He has been named principal investigator for the Rhode Island Hospital clinical trials. Using transesophageal echocardiograms, Athena Poppas, MD, a co-investigator with Williams, is interpreting the results from all sites, including those performed in Germany, Switzerland, Italy and Canada. Cardiologist Thomas Drew, MD, also a co-investigator, assists Williams in doing the procedures.
Williams first performed the procedure, known more specifically as a percutaneous left atrial appendage transcather occlusion (PLAATO™), on a laboratory animal in California. He said, “The clinical trials will evaluate the effectiveness of the device. My own judgment is that it will prove to be very safe and effective. Although these trials are limited to high-risk patients, I would not be surprised if one day this simple implant eliminated the need for Coumadin in patients with atrial fibrillation.”
Rhode Island Hospital is a Lifespan partner and a major teaching hospital for Brown Medical School.
