Awake LAAO Surgery Gives Patients More Freedom

Providing the latest and most advanced cardiac care to patients throughout the region for decades, Baystate Health is now the first and only hospital in western Massachusetts to offer a new option for those undergoing left atrial appendage occlusion (LAAO) procedures involving the WATCHMAN or Amulet implantable device.

“Our patients undergoing LAAO will now have the opportunity to elect having the procedures performed with just local anesthesia and mild sedation for their comfort, known as conscious sedation, as opposed to general anesthesia,” said Andrew M. Goldsweig, MD, MS, director of the Cardiac Catheterization Laboratory and director of Cardiovascular Clinical Research at Baystate Medical Center.

“Being able to perform these procedures for awake patients means none of the discomfort and risks of general anesthesia, and most patients will be able to go home the same day. Most importantly, people with atrial fibrillation (AFib) undergoing LAAO have protection from stroke but never need to take blood thinners again,” he added.

Dr. Goldsweig performed the first four conscious left atrial appendage occlusion procedures at Baystate Medical Center on May 3 and has since performed several more.

The First Patient

One of the first patients to undergo the awake procedure on May 3 was Anthony Odierna of Longmeadow.

“I went for a normal physical, wasn’t having any problems, and that’s when my doctor suspected that I had AFib. I had no symptoms and have felt great for years. I never drank, not a coffee drinker, don’t smoke, and I constantly exercise and play hockey,” said Odierna, 78.

His next doctor’s visit was with Dr. Goldsweig.

“Dr. Goldsweig was very disarming and told me we had as much time as I needed to go over everything and ask him any questions. He explained everything so wonderfully and even drew pictures, so that it was very clear to me what I would be undergoing and its benefits for my health. At first, it made me a little uneasy knowing that I would be awake as someone penetrated my heart. I felt nothing as he promised and it turned out to be a simple, easy, totally painless procedure,” Odierna said.

Everything Went Well

The Longmeadow man noted he had a “marvelous experience” while at Baystate Medical Center.

“Everyone was so personable from the time I checked into the hospital through the procedure with all the doctors and nurses taking care of me to my discharge before I went home later the same day,” Odierna said.

“I’m a lucky guy,” he added about now having recovered from the procedure and back to a normal life. “There are so many people hurting in this world today, and what I went through was minor compared to the problems so many others are faced with.”

For Those with AFIB

The LAAO procedure is performed for patients like Odierna with atrial fibrillation, which is an abnormal heart rhythm that affects up to 25% of Americans at some point in their lives. In AFib, the top two chambers of the heart (atria) don't squeeze normally, so blood flows through them very slowly. The top left chamber (left atrium) has a pocket (left atrial appendage) where slow-flowing blood can form clots, which block oxygen rich blood from reaching the brain, resulting in stroke. 

According to Dr. Goldsweig, AFib was historically treated with blood thinners to prevent blood clot formation. However, blood thinners carry a risk of bleeding – including potentially life-threatening bleeding in the gastrointestinal tract or brain – and not every patient can tolerate blood thinning medications like warfarin (Coumadin), apixaban (Eliquis), or rivaroxaban (Xarelto). These medications can also limit patients’ active lifestyles due to concerns about bleeding.

Until the advent of LAAO, there were no therapies available to prevent stroke for AFib patients who could not tolerate long-term anticoagulation medicines. WATCHMAN (made by Boston Scientific) and Amulet (made by Abbott) are implantable devices that have been proven to reduce the risk of stroke in patients with AFib just as well as anticoagulation.

How it Works

During the minimally-invasive LAAO procedure, a plug (WATCHMAN or Amulet) is placed into the left atrial appendage. A tiny catheter (a tube 1/8 of an inch in diameter) is inserted into a leg vein and advanced to the heart to deliver the plug. Heart tissue then grows over the plug in about six weeks, and the appendage is closed forever.

Amir Lotfi, MD, chief of Cardiology in the Heart & Vascular Program at Baystate Health, along with electrophysiologist Dr. Marshal Fox, performed the first WATCHMAN implant at Baystate Medical Center in 2018.

“Our introduction of the WATCHMAN implant for area patients is another example, like the new awake option brought to Baystate by Dr. Goldsweig, of how Baystate continues to provide leading-edge technology in order to enhance the lives of our patients and that of their families,” said Dr. Lotfi.

Previously, patients like Odierna undergoing LAAO required general anesthesia, a breathing tube, and paralytic medications to allow for procedural guidance using an ultrasound catheter placed through the mouth into the esophagus. However, new 3-dimensional intracardiac echocardiography (3D-ICE) now available at Baystate can replace this invasive imaging. 3D-ICE is performed with an even smaller catheter than LAAO (1/12 of an inch diameter) placed alongside the LAAO catheter. With only these two tiny catheters and nothing in the esophagus or trachea, patients can receive LAAO with local anesthesia at the leg vein site and light sedation.

“This is a big advance in cardiology, and we are excited to be performing conscious LAAO procedures in western Massachusetts and are thrilled to be able to offer this advanced level of care close to home in the many communities we serve,” said Dr. Goldsweig, who joined the cardiology staff at Baystate in January.