WellSpan Health is a national leader in left atrial appendage occlusion (LAAO) research, technology and procedures. Their aim is to reduce stroke risk in atrial fibrillation (Afib) patients who are not amenable to anticoagulation. 

The left atrial appendage (LAA) is a small pouch within the left atrium that is formed during embryonic development. The primary location where patients with Afib form a thrombus, the LAA contributes to the five-fold increase in stroke risk for Afib patients. Traditionally, patients with Afib have been placed on anticoagulant medications to reduce their risk of stroke, but LAAO procedures are an excellent alternative for patients for whom anticoagulation is not appropriate.  

LAAO procedures are minimally invasive, performed endoscopically through a puncture in the groin to advance and deploy an LAAO device to close off the LAA. Endothelial tissue then grows over the device, permanently sealing off the LAA. The procedure is generally well tolerated, and most patients can be discharged after only a one-night hospital stay. 

NO.1 NATIONWIDE IN LAAO

WellSpan Health has paved the way for LAAO procedures through research and implantation of hundreds of LAAO devices. “With the assistance of multiple research coordinators, WellSpan Health has been involved in most of the major studies for LAAO that are leading the way to change indications or introduce new devices,” says Brian Schuler, MD, FACC, System Director of Cardiac Electrophysiology at WellSpan Health. “We started with the Amplatzer Cardiac Plug, an early generation of what is now called the Amulet device. We now implant the WATCHMAN FLX device after previously implanting the legacy WATCHMAN device.” 

PATIENT SELECTION 

Candidates for LAAO include those who have nonvalvular Afib and a high risk of major bleeding or falling. Newer studies are aimed at identifying whether LAAO is superior to newer oral anticoagulants in patients with a high risk of stroke regardless of their bleeding risk.  

WellSpan Health invested in several technologies, including a CT angiography suite, to improve their patient outcomes. The program’s extensive preprocedural planning sometimes entails imaging and 3D printing a replica of a patient’s heart to ensure that physicians have the correct-sized device to achieve the perfect fit.  

Traditionally, ultrasound helps to ensure correct placement of the LAAO device and check for leaks. However, WellSpan Health uses CT angiography to ensure absolute accuracy. Dr. Schuler says this helps to identify an additional 10%–15% of patients with a leak around the device that was missed on transesophageal echocardiogram. The amount of radiation exposure is very low — typically 1–3 millisieverts of radiation.  

“We pioneered a new way to do the procedure,” Dr. Schuler says. “We think it’s probably the best way to deploy it because you eliminate a lot of issues by evaluating the device with the 20/20 vision provided by CT."

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