 I am Dr. Ranjan Shetty, HOD cardiology in Manipal Hospital, Bangalore. Today I would like to talk about atrial fibrillation and stroke prevention. Stroke is a deadly disease. Here I remember 80-year-old Mr. Gowda who had suffered from a stroke and who had luckily recovered. At that particular time it was diagnosed that he had atrial fibrillation. That was the cause for his stroke and he was started on anticoagulation which is a strong blood thinner. But unfortunately, 2-3 months after taking this medicine he started developing GI bleed. He started passing back tools. He was unconscious and he was brought to the emergency in this condition. We had to stop his anticoagulation. We had to give him blood to resuscitate. At this point we realized that he was in trouble. Now he cannot take blood thinner which would prevent his stroke because if he does take that he would start bleeding and that would risk his life. Patient being a very intelligent patient knew that the recurrence of stroke would be actually very disabling and he would be dependent on others to take care of himself. He was very much worried and that's when he came to us. Fortunately, we could offer him alternative therapy where a device is put into his left atrial appendage and there was no need for him to take this difficult medicine. Atrial fibrillation is a very common arrhythmia. If you look at the population, lots of people do have atrial fibrillation. At age of 60, 1% of the population has atrial fibrillation. At 80-85, 5-10% of the population has atrial fibrillation. What we mean by atrial fibrillation is abnormal heart beat. Now this produces two types of problems. One problem is the heart beat itself which is abnormal which your doctor can pick up, a simple ECG can pick it up but that's not the major problem. The major problem is formation of the clot which occurs in the heart and later this clot goes to brain and produces what we call as stroke or paralysis. Stroke or paralysis produced by atrial fibrillation is more dangerous than the routine stroke and it is believed around 20 to 30% of the stroke which occurs in population is because of this one disease. Now this stroke is more disabling and it is both mortality and morbidity is higher in this kind of stroke. To prevent this, there are some effective therapies which are available. One of the effective therapy which is available is a drug which is called anticoagulation. But when we are talking about these drugs or blood thinners, we are not talking about drugs like aspirin. They are very simple to manage and most people do take this drug. But these stronger drugs are very dangerous. If you take it in excess or if it is not monitored properly, the patient could have had bleeding, blood could become very thin and they could have lot of internal or external bleeding or if it is taken in under doses, then they could still have stroke. So it's a very thin line and we think it is like a double-edged sword. If you look at atrial fibrillation and if you look closely inside the heart, most of the clot that is more than 90 to 95% of the clot actually come from one area which we call as left atrial appendage. Now this is the extra pouch which is found in the left side of the heart. It does not have any useful normal function but can produce lots of harm. So since the clot is coming from one particular area, it makes logical sense that you close this area of safely and effectively in which case you don't need those strong blood thinners. Left atrial appendage closure or LA closure, the procedure is done like angiogram or angioplasty. Hence it is just a microscopic or a very minimal procedure. It's not a surgery. There is no chest opening in this procedure anywhere. So what is done here is it is done through the groin. So a femoral vein or a vein in the leg is punctured using a needle which is very small. The whole puncture site is likely to be 2 to 3 mm. Hence it is very miniature and it is very small. Through this catheter is passed and you reach from the leg to the heart. You go from right side, you puncture the septum and go to the left side. You view this structure very well both using angiogram as well as in echocardiogram. Once you view, you select one particular device, a particular site which will be specific to that patient and then you close off the area. So if this procedure is done in a very effective way, very safe way, the left atrial appendage gets excluded from circulation. That means the area which produced the clot is now no longer part of our normal blood flow, hence chance of forming a clot and that clot going to brain or any other vital organ gets reduced by 90 to 95%. The advantage is this is just one time procedure and once you have done it, you don't have to worry about taking the strong blood thinners for life. Now this would be very useful for people who cannot take anticoagulant or strong blood thinners for any reason. For example, somebody with a stomach ulcer or somebody who has tendency to fall, somebody who is in a very competitive sports where the chance of injury is higher or any work where chance of injury is higher, somebody who is likely to bleed a lot for whatever reason. In them, instead of taking a strong blood thinner, they could actually use this. It's also useful in some other patients who say have kidney failure and have atrial fibrillation. It is useful in some of the angioplasty patients where they are already on aspirin and clopidogrel. So taking three strong blood thinners becomes extremely dangerous. In some of the patients, even though they are taking strong blood thinner, they could still develop stroke. In them, this could be used as an add-on therapy. So just to summarize in nutshell, it's a very effective therapy. If done properly, it requires good imaging modality like transesophageal echo and also fluoroscopy which is done in a routine cath lab. We do have a lot of experience in doing this procedure and most people after the procedure are extremely happy because now they do not have to take strong blood thinner and also are worried about the stroke because stroke is now reduced by more than 90%.