Simple Surgery Reduces Stroke Risk in People with Heart Arrhythmia

Simply removing a small appendage on the heart can reduce the risk of stroke for people with heart arrhythmia, according to a new study by researchers at McMaster University in Ontario, Canada.

The left atrial appendage is an unused, finger-like tissue that can trap blood in the heart chamber and increase the risk of clots. Removing it can cut the risk of stroke by more than a third in people whose hearts either beat too fast, too slowly, or irregularly, the researchers reported.

The reduced risk created by removal just adds to the benefits conferred by blood thinner medications that doctors usually prescribe to people with arrhythmia.

“If you have atrial fibrillation and are undergoing heart surgery, the surgeon should be removing your left atrial appendage because it is a setup for forming clots,” said Dr. Richard Whitlock, the study’s author and a professor of surgery at the Canadian university, in a statement. “Our trial has shown this to be both safe and effective for stroke prevention.”

“This is going to have a positive impact on tens of thousands of patients globally,” he added.

The study followed 4,811 people taking blood thinners for atrial fibrillation in 27 countries. Participants who underwent cardiopulmonary bypass surgery were randomly chosen for the additional procedure of removing the left atrial appendage.

Researchers compared outcomes with those who only took blood thinners over a median of 4 years. The average age of the patients was 71.

The study was recently presented at the American College of Cardiology conference and published today by the New England Journal of Medicine.

Cardiologists discuss benefits

Two California cardiologists told Healthline that surgeons have already been closing the left atrial appendage to decrease the odds of heart patients having a stroke.

Dr. Nikhil Warrier, the medical director of electrophysiology at Orange Coast Medical Center in Fountain Valley, said the procedure “is an attractive option for closure or litigation in patients who are at high risk for stroke and not ideal candidates for long-term blood thinners.”

Warrier said the procedure can take people off blood thinners altogether.

“With surgical ligation of the left atrial appendage, the option to discontinue blood thinners is available for patients who are at high risk of bleeding or have had issues with it,” Warrier said.

Dr. Shephal Doshi, the director of cardiac electrophysiology and pacing at Providence Saint John’s Health Center in Santa Monica, said the practice of removing the appendage — which he said is an embryologic structure that forms early in fetal development — hasn’t resulted in any negative outcomes.

“When people go for open-heart surgery, we often ask the surgeons while they’re there to close it. Just like anything else in medicine, the concept may make a lot of sense, but until we can prove it in a clinical trial, we cannot start doing this to patients,” Doshi said.

“It took us years of experience and trials to finally show us that the appendage is important in forming the blood clots in atrial fibrillation. And if it can be easily closed during surgery, then we are moving toward recommending for patients to have it closed if they have a history of atrial fibrillation going for open-heart surgery,” he said.

A quick, safe procedure

The study’s co-principal investigator, Stuart Connolly, said in a statement that the study’s results “will change practice right away, because this procedure is simple, quick and safe for the 15 percent of heart surgery patients who have atrial fibrillation. This will prevent a great burden of suffering due to stroke.”

Whitlock said researchers have suspected the link between blood clots and the left atrial appendage since the 1940s, and that the procedure just makes sense.

He said the procedure can also be done for people not needing heart surgery through less invasive methods, which will be important for research moving forward.

“This is an inexpensive procedure that is safe, without any long-term adverse effects, and the impact is long term,” Whitlock said.