quote Originally posted by cliffw: First of all, best wishes Don. If you need anything I can help you with, all you need to do is ask. I have a questions of my own. I don't understand the procedure. They release the doo hickey and it is permanently implanted ? What keeps it in place ?

Fixation barbs. There are tiny barbs on the outside of the springy stainless steel part of the device that engage the wall of the appendage itself, and most LAAs are shaped such that the entrance is a bit smaller than the rest of the cavity as well.
After a few weeks, tissue (endocardium) normally grows over the device and it becomes permanently in place regardless of the barbs.

quote My dumb mind thinks it is on the outflow path of blood from the heart. Why not the inflow, to keep clots from entering the heart ? Your descriptive image says "it stops harmful blood clots from entering the blood stream". How so ? Where do clots come from ? I thought they were formed in the blood stream.

No...The clots form IN and come FROM the LAA.

The Left Arterial Appendage is just a little out crop from that chamber of the heart. It is a void..a single opening to the left atrium (top left chamber of the heart) ..no 'outlet'.. Everyone has one. It is postulated that at some time in our long biological development, it may have been a useul organ or even an artery that led somewhere, but now is just a little empty, closed ended outcrop of tissue, about the size (and often roughly the shape) of a single broccoli floret. Blood doesn't actually 'flow thru" it. It pools up in it and anytime blood pools, it coagulates--forms clots. For most people it isn't an issue, as blood flow thru the heart is a pretty smooth un-interrupted flow and the clots within the LAA just stay there or slowly dissolved and/or reincorporated into blood or carried off as waste. But, when you have Afib, that smooth flow is changed as the different chambers are no longer electrically in sync with each other. Eddys whirlpools and backflows in the flow begin, and there is a high risk of a clot being dislodged from the LAA and entering the bloodstream which is the #1 cause of stroke.

Most people don't realize just how quickly blood makes the complete path from heart, thru the body and back to the heart. It's very fast. Didn't realize it myself until I started having CT scans with iodine contrast. You're in the CT machine with an IV in your arm, and the tech says "OK, I'm going to introduce the iodine. You will feel a warm sensation in certain parts of your body".
It happens in seconds..less than 30 for sure, closer to 10 seconds..you feel it in your gonads, lymph nodes, pancreas, and other places. (the 1st time, I had to look to see if I had not peed or ejaculated..it was just an odd warm feeling everywhere. So, once a clot is dislodged, it can make the trip up to your brain PDQ.

Blood thinners...these are the 1st line of defense against stroke for heart disease patients, especially those who have had bypass surgery and have afib. I have been on an aspirin/day since Sept 2015, have been on every blood thinner/anti-platelet there is except warfarin (Plavix, Zarelto, Pradaxa, Eliquis). All cause a problem I haven't talked much about at all.

Certain people (myself included) bleed spontaneously and for no explainable or predictable reason when on the better blood thinners, usually internally thru mucus type membranes. In the last 6 months, I've bled from my eyes, my nose, thru my urine and probably in my poop. I've been to the emergency room several times for blood in my urine, and not just a little. Christmas Day, I began bleeding from my nose for no reason, and twice have had bloody tears from my eyes. The urinary bleeding is the worst. It's shocking, after 67 years of yellow piss, to look down and see a steady dark red or brown stream, and persists for several days if I don't get off blood thinners. And of course, with my active lifestyle working with machinery, fencing and cattle, I'm constantly cutting and bruising myself and bleed like a pig if I'm on thinners. My urologist wanted to know why I was having this procedure done and he had never heard of it, but after me explaining everything, he even seriously asked if I had been out of the country and visited West Africa places like Nigeria where Ebola was a risk. It's disconcerting to wake up in the morning and find a bloody pillow from one of your eye sockets bleeding. And of course, I get anemic sometimes when having the bleeding problem.

I will tho, be on warfarin for 8-12 weeks after the procedure because there is a likelihood that implanting the device itself will dislodge a clot.
It will not be fun. A weekly blood draw to measure how much warfarin I have in me at any time.

[This message has been edited by maryjane (edited 04-18-2018).]