Our Services / Cardiology Consultation / Cardiac Testings / Treatments

An office schedule for an exercise stress test may be obtained through your primary care physician's office or through our cardiologists. The result of the test should be available to your primary care physician within 24 hours. Your primary care physician will be urgently informed of any significant abnormal findings.

Cardiac stress testing is usually performed to screen for blockages in the heart arteries or to estimate future outcomes of patients with known heart disease. There are two parts to the stress testing. First is the method of stress (walking or chemical stress testing). The second is the method of seeing the strain on the heart muscle (ECG alone or combined with heart imaging - sonogram or isotope imaging). The best suited method of stress testing is the walking stress test if the patient is able do so. It is conventionally done on a treadmill, which starts at low speed and elevation which gradually increases every three minutes until the patient has achieved adequate stress on the heart according to a calculated age-related heart rate. The ECG is continuously monitored in all patients during stress. Many patients may also have a heart images taken before and after stress testing for comparison. The capacity to exercise may also provide a predictor of a future heart event. With increasing age, obesity, and other ailments such as emphysema, or back, hip or knee problems, many patients may not be able to exercise adequately to stress the heart. In such patients, a chemical stress test may be a better choice. Some low level exercise may remain useful in some chemical stress tests as the exercise may reduce the side effect of the drug used.

Stress testing is a very good but imperfect method of screening for heart artery blockages. While the stress test with an ECG monitoring alone may be adequate for some patients, the addition of heart imaging to the stress test will increase the accuracy of the test. 

Instructions Prior to Testing: Walking/chemical stress cardiolite or stress echocardiogram.

Do not take any beta-blocker 24 hours prior to the test. This includes atenolol (Tenormin), Metropolol (Lopressor), Tropol XL, Carvedilol (Coreg), Propanalol (Inderlol), Nebivolol (Bystolic), and Labetalol.

Do not take these calcium channel blockers 24 hours prior to the test: Verapamil (Calan) or Diltiazem (Cardizem, Tiazac or Cartia).

If you are having an isotope stress test (thallium or cardiolite), please do not have any caffeine for 24 hours prior to the test. This includes decaffeinated or regular coffee, soda, chocolate or tea.

Do not eat or drink anything after midnight except sips of water only. For testing scheduled in the afternoon, you may have a light caffeine-free breakfast before 7:00 am (toast, jello or juice).

If you are diabetic, cut insulin dose and/or diabetic pill in half the evening before the test. Do not take any insulin or diabetic pills the morning of your test. If you are unsure about the instruction, please call our offices.

Bring a snack with you to eat halfway through the test.

Plan to be here for at least 4 hours if you are having a chemical stress test.

Wear loose, comfortable clothing and lace up walking shoes. Please wear short sleeves so we may have access to your arm to start an IV.

Do not wear any lotions, powders, creams, or necklaces on the day of your test.

To avoid being charged for the medicine that we order for the test, cancellation 24 hours prior to the test is required. 

An echocardiogram is an ultrasound test of the heart that takes about half an hour to one hour to perform and carries no significant risks. The test is used to evaluate how well your heart muscle is pumping. An echocardiogram with doppler study, which utilizes an ultrasound imaging in conjunction with blood flow study can assess heart valve motion and function accurately. The test can also detect if there is any abnormal fluid build-up around the heart. With the injection of saline (salt water), holes in the heart may become apparent. Contrast agents can also be used with an echocardiogram to see if there are large clots present in the heart chambers. 

Instructions Prior to Testing: with Doppler or bubble study.

You do not have to be fasting.

Plan to be here for 1 hour.

Please wear short sleeves so we may have access to your arm to start an IV if needed.

Do not wear any lotions, powders, creams, or necklaces on the day of your test.

A TEE is an ultrasound test of your heart obtained through your food pipe as it goes behind your heart. You will be sedated and your throat will be made numb with a lubricating gel. You will be assisted to swallow an imaging instrument (a probe), which is similar to a scope used by a gastroenterologist to examine patient's food pipe and stomach lining. Most patients do not remember the test once it is over. A TEE is done when the usual echo images are not optimal for interpretation or there is a need to assess for clots in the back of the heart. It is also often performed in patients with suspected defective or artificial heart valves to look for clots or vegetations. If a hole in your heart is detected with salt water injection during a regular echocardiogram, the TEE will provide accurate pictures of the hole so applicable treatment can be planned.

Instructions Prior to Testing:

Do not have this procedure if you have loose teeth, mouth sores, or recent exposure to COVID-19.

Do not eat or drink for six hours before your test.

Be sure to take all your normal morning medications the day of your test. Drink only the smallest amount of water necessary to swallow your medicines. You do not have to stop taking blood thinners.

Bring an up-to-date list of your medications with you on the day of your test, and let your nurse know what you have already taken that morning.

Be sure to notify the doctor or nurse if you have any allergies, difficulty in swallowing or problems with your mouth, esophagus or stomach.

Dentures should be removed.

You will not be allowed to eat or drink for a few hours after the procedure until you are alert and able to swallow safely.

Make arrangements in advance for transportation home; you will not be allowed to drive yourself home.

An office appointment for a 24-hour or 30-day heart monitor may be obtained through your primary care physician's office or through our cardiologists. The result of the test should be available to your primary care physician soon after you return the monitor to our office for analysis. A longer heart monitoring duration may be necessary in some unusual situations and this may be done with an implantable device as small as a stick of chewing gum. The device is implanted similar to a pacemaker and it may be left in for up to 18 months. This procedure requires a minor incision and can be done as an outpatient. The device may be periodically evaluated with a computer program in the office using a tool similar to a pacemaker check, if needed.

Instructions Prior to Testing: 24-hour Holter or 30-day event recorder.

You do not have to be fasting.

Plan to be here for 30 minutes.

Do not wear any lotions, powders, creams, or necklaces on the day of your test.

Blood vessels elsewhere in the body can become clogged up with cholesterol build-up just like arteries in the heart. This is called peripheral arterial disease.

The available preliminary tests that are used to detect PAD in our offices are Carotid Doppler and Ankle-Brachial Index (ABI). These tests are quick and carry no significant risks or discomfort.

Carotid Doppler is an ultrasound test of the neck area that evaluates the presence of blockages in the carotid arteries as blockages in those arteries can lead to an increased risk of stroke.

Ankle Brachial Index is a test that compares blood pressure readings in your arms and legs. Normally blood pressures in the legs are higher than the arms. If the leg arteries start clogging off (commonly in smokers), the blood pressure in that leg will fall below the arm pressure. The pressures are taken in the thigh, leg and toes and compared with the pressure in the arms.

Instructions Prior to Testing: 

You do not have to be fasting.

Plan to be here for 60 minutes for each.

Do not wear any lotions, powders, creams, or necklaces on the day of your test.

Cardiac catheterization is a procedure that is performed to evaluate the heart arteries, heart muscle, and heart valves by taking real-time images of the arteries and main pumping chamber with X-ray equipment specifically designed for this purpose. Measuring of pressures within various heart chambers may be needed to provide additional data to make the diagnosis. It can be preformed through a puncture site in either the groin or the wrist. This procedure is typically performed in a cardiac catheterization laboratory within the hospital.

Instructions Prior to Testing:

Preliminary blood work/recent EKG is required prior to the heart catheterization.

If you are currently taking Coumadin, generally it will need to be stopped 3 days prior to the procedure unless otherwise instructed by our office staff. Make sure to discuss this with our cardiologist/office.

Let us know if you have a history of X-ray dye allergy or kidney disease. You may need to be premedicated a few days before the procedure.

If you are diabetic, cut insulin dose and/or diabetic pill in half the evening before the test. Do not take any insulin or diabetic pills the morning of your test. If you are unsure about the instruction, please call our offices.

Do not eat or drink after midnight the evening before your test.

Be sure to take all your normal morning medications the day of your test (except for water pill, Coumadin and diabetic medicines). Drink only the smallest amount of water necessary to swallow your medicines.

Bring an up-to-date list of your medications with you on the day of your test, and let your nurse know what you have already taken that morning.

Make arrangements in advance for transportation home; you will not be allowed to drive yourself home. Patients undergoing diagnostic cardiac catheterization are expected to go home the same day unless stenting is preformed then patients are likely to be kept in the hospital overnight.

Discharge Instructions after Cardiac Catheterization Procedure: 

Activity:

No heavy lifting over 10 pounds for one week or as directed by your cardiologist.

No driving for two days after plastic tube removal from the puncture site.

No strenuous activity with affected leg for one week (i.e. jogging, swimming, running, raking, or the mowing lawn).

No exercising or excessive use of stairs for one week (in cases where groin approach is used).

Puncture Site Care:

Remove the dressing next day.

To prevent infection, a shower is preferred to a tub bath for at least one week.

Wash with soap and water daily in the shower.

Do not apply any creams or lotions to puncture site.

Inspect your puncture site daily. Notify the office immediately of increased bruising, swelling, excessive pain, redness, drainage, foul odor or a fever (more than 100.5°F). A small knot may develop in the groin area if plug device is used. It generally resolves in about two weeks.

For questions/concerns use the contact information at the top of this page.

Physiologic Lesion Assessment is a special technique that is used to assess the exact effect of the artery blockage on the blood flow to the heart muscle and this may be performed in continuation of the regular dye test. This assessment will determine the need for the treatment with balloon, stent, or bypass procedure to restore normal blood flow to the heart muscle. This technique is called instantaneous flow reserve (IFR), in which a special wire, a guidewire, is used to measure the pressure generated before and after the narrow area in the heart artery. There will be a substantial drop of the pressure reading beyond the blockage if the blockage is of significant degree and thus the patient will benefit from balloon or stent treatment to treat the blockage.

Peripheral Vascular Angiography is a procedure that is used to identify the severity and location of the blockages in blood vessels outside the heart, peripheral arterial disease. The peripheral vascular angiography is performed by inserting a small plastic tube into the artery of a leg or an arm, and x-ray dye is used to take pictures of the artery. The severity of the blockage will help determine the benefit of treating the blockage by balloon, stent, or other modalities.

Instructions Prior to Testing:

Preliminary blood work/recent EKG is required prior to the Peripheral Vascular Angiography.

If you are currently taking Coumadin, generally it will need to be stopped 3 days prior to the procedure unless otherwise instructed by our office staff. Make sure to discuss this with our cardiologist/office.

Let us know if you have a history of X-ray dye allergy or kidney disease. You may need to be premedicated a few days before the procedure.

If you are diabetic, cut insulin dose and/or diabetic pill in half the evening before the test. Do not take any insulin or diabetic pills the morning of your test. If you are unsure about the instruction, please call our offices.

Do not eat or drink after midnight the evening before your test.

Be sure to take all your normal morning medications the day of your test (except for water pill, Coumadin and diabetic medicines). Drink only the smallest amount of water necessary to swallow your medicines.

Bring an up-to-date list of your medications with you on the day of your test, and let your nurse know what you have already taken that morning.

Make arrangements in advance for transportation home; you will not be allowed to drive yourself home. Patients who undergo Peripheral Vascular Angiography and or intervention are expected to go home the same day.

Percutaneous Coronary Intervention (PCI) includes a variety of procedures that are used to treat patients with diseased arteries of the heart, caused by a build-up of fats, cholesterol, and other substances in the blood vessel wall. This is commonly referred to as plaque build-up that may reduce blood flow to the heart.

PCI, which is performed by threading a slender balloon-tipped tube (a catheter) from an artery in the groin to a narrow spot in an artery of the heart is referred to as Percutaneous Transluminal Coronary Angioplasty (PTCA, coronary artery balloon dilation or balloon angioplasty). The balloon is then inflated, compressing the plaque and dilating (widening) the narrowed heart artery so that blood can flow more easily.

Discharge instructions can be found at the bottom of the stent section below as all discharge/care instructions are the same regardless of the method used to treat blockage.

Sometimes plaque within the heart artery may contain a large amount of calcium that can make the blockage difficult to dilate or open. In this case, plaque modification is necessary to allow for the blockage to be dilated. Physicians utilize a variety of methods to soften the plaque including the use of shockwave angioplasty (which delivers ultrasound waves similar to what is used to break kidney stones), laser phototherapy, and Rotational Atherectomy known as rotablator (a mini-drill that rotates at high speed with a diamond-studded burr). Once the blockage is modified, an intracoronary stent insertion is usually performed to hold the modified artery open. The patient who receives a Plaque Modification will require similar post procedural care as in the stent only treatment below.

Discharge instructions can be found at the bottom of the stent section below as all discharge/care instructions are the same regardless of the method used to treat blockage.

The stent procedure often accompanies the balloon angioplasty procedure. A stent is a wire mesh tube that is used to prop open a heart artery during angioplasty. The stent is collapsed to a small diameter and put over a balloon catheter. It is then moved into the area of the blockage. When the balloon is inflated, the stent expands, locks in place and forms a scaffold. The stent stays in the artery permanently and it holds the artery open to improve blood flow to the heart. Stents are used depending on certain features of the artery blockage, including the size of the artery and the location of blockages in the artery. Stents also help restore normal blood flow and keep an artery open if it has been torn or injured by the balloon catheter. Stenting is a fairly common procedure and it now represents over 90 percent of PCI. Reclosure (restenosis) of the artery after the stent treatment can occur, thus drug-eluting stents are commonly deployed in blockages. Drug-eluting stents are coated with drugs that are slowly released to prevent the blood vessel from re-closing. 

Patients who have had a stent procedure must take one or more blood-thinning agents. Aspirin and Clopidogrel (Plavix) or Ticagrelor (Brilinta) are universally used in combination post stent deployment. Aspirin is usually used indefinitely; Clopidogrel or Ticagrelor is used for one to twelve months, depending on the type of stent used. It is important that you DO NOT STOP taking Clopidogrel or Ticagrelor without consulting your doctor as inappropriate stoppage of these medications can result in clot formation within the stent which causes heart attack. Metal detectors DO NOT affect the stent.

Discharge Instructions after Stent Procedure: 

Activity:

No heavy lifting over 10 pounds for one week or as directed by your cardiologist.

No driving for two days after plastic tube removal from the puncture site.

No strenuous activity with affected leg for one week (i.e. jogging, swimming, running, raking, or the mowing lawn).

No exercising or excessive use of stairs for one week.

Puncture Site Care:

Remove the dressing next day.

To prevent infection, a shower is preferred to a tub bath for at least one week.

Wash with soap and water daily in shower.

Do not apply any creams or lotions to puncture site.

Inspect your puncture site daily. Notify the office immediately of increased bruising, swelling, excessive pain, redness, drainage, foul odor or a fever (more than 100.5°F).

You may develop scar tissue at the puncture site. This is normal and will feel like a small lump under the skin. You may feel this lump for some time.

For questions/concerns use the contact information at the top of this page.

Patent Foramen Ovale is the persistence of a natural communication between the two upper heart chambers that remains open after birth. Whereas Atrial Septal Defect is the communication between the two upper chambers as a result of a birth defect. 

Too large a communication may allow blood flow from the left to right (ASD) or right to left (in the case of PFO) upper heart chambers and place a burden to the heart circulation. Few patients may suffer recurrent strokes due to the cross-over of a blood clot from the lower part of the body into the left heart circulation. The potential excessive circulation burden and recurrent strokes are indications for PFO or ASD closure.

One or more tests will be done to measure the PFO or ASD and to make sure there are no other defects. An ultrasound imaging with an echocardiogram is used to estimate the size of the closure device needed. Another technique uses an ultrasound probe passed down the esophagus (transesophageal echocardiogram, or TEE) to allow your doctor to see the heart structures and blood flow in more detail.

The cardiac catheterization procedure for a PFO or ASD closure typically takes 30 minutes to complete. The catheter is initially inserted into a large vein in the groin area and then it is advanced into the heart. A local anesthetic is used to numb the area where the catheter was inserted. The use of general anesthesia or intravenous sedation depends on the doctor's preference and the patient’s need. A closure device is moved through the catheter to the location of the heart wall defect and the device is allowed to expand its shape to straddle each side of the hole. The device will remain in the heart permanently to stop the abnormal blood flow between the two upper heart chambers. The patient will not be able to feel the device.

Your doctor will prescribe medications that will need to be taken at home. Aspirin or other blood-thinning drugs will need to be taken for 6 months or longer to prevent blood clots from forming on the device while it heals in place. Do not stop taking the medication without consulting with your doctor first. It will be necessary to repeat imaging of the patient’s heart and device placement, at one month, six months, and one year after the procedure.

The materials used in the closure device products have a proven long-term safety history and have been widely used in heart surgery procedures. It’s not likely that the body will have a negative reaction to these devices. Within a few days, the heart tissue will begin to grow over the device and it should completely cover the device by three to six months. The occluder device will not be affected by airport or other security sensors, household appliances, or medical imaging methods. You will receive an identification card that should be carried with you to show to medical personnel if necessary.

Renal Artery Stenosis (RAS) is a medical condition in which one or both renal (kidney) arteries become narrow from cholesterol plaque build-up or overgrowth of blood vessel lining. RAS may lead to severe uncontrolled high blood pressure, kidney function impairment and symptoms of heart function impairment including severe chest pain and sudden fluid congestion with marked shortness of breath. Without an appropriate treatment, RAS may eventually become completely occluded and lead to renal function impairment. Currently RAS is treated (if indicated) non-surgically using balloon angioplasty/stent placement.

The screening procedure for RAS may be performed using an ultrasound of the kidney and its arteries or CT angiogram of the stomach area. Renal angioplasty is performed under local anesthetic and intravenous sedation primarily via leg artery access at the groin area. Patients usually leave the same day.

Peripheral arterial disease is a collective disease of the arteries that supply legs, arms, brain and other organs. Atherosclerosis or hardening of the arteries leads to a significant narrowing of these arteries and reduction in blood flow to these organs. With appropriate medical care and management of risk factors, patients can significantly reduce their health risks of developing PAD. Patients with PAD are also at high risk for heart attack and stroke. While PAD is common and affects over 10 million people, only one in four is diagnosed and receives treatment.

The treatment of PAD depends on the severity of symptoms, the degree and extent of arterial narrowing and patient’s overall health. Patients with PAD should be prescribed for therapeutic life style changes, exercise programs, and medication to control their risk factors. Patients with open wound or chronic ulcer may require specialized wound care. Endovascular therapy or surgery may be necessary to reopen the arteries and improve blood flow.

Endovascular therapy is a non-surgical treatment for PAD that utilizes balloon angioplasty, plaque removal (Atherectomy), stent insertion. The balloon angioplasty is performed by threading a slender balloon-tipped tube (a catheter) from an artery in the groin or elbow to a narrow spot in a limb artery. The balloon is then inflated, compressing the plaque and dilating (widening) the narrowed artery so that blood can flow more easily. Commonly balloons coated with drugs that prevent vessel re-narrowing are utilized.

The stent procedure often accompanies the balloon angioplasty procedure. A stent is a wire mesh tube that is used to prop open an artery during angioplasty. The stent is collapsed to a small diameter and put over a balloon catheter. It is then moved into the area of the blockage. When the balloon is inflated, the stent expands, locks in place and forms a scaffold. The stent stays in the artery permanently and it holds the artery open to improve blood flow. Stents are used depending on certain features of the artery blockage, including the size of the artery and the location of blockage in the artery. Stents also help restore normal blood flow and keep an artery open if it has been torn or injured by the balloon catheter.

Patients who have had PAD intervention (whether balloon or stent insertion) must take one or more blood-thinning agents. Aspirin and Clopidogrel (Plavix) are universally used in combination post stent deployment. Aspirin is usually used indefinitely; Clopidogrel is used for one to twelve months, depending on the type of stent used. It is important that you DO NOT STOP taking Clopidogrel without consulting your doctor as inappropriate stoppage of these medications can cause in clot formation which results in acute closer of the intervention site.

Insertion of a permanent pacemaker is a treatment where an outside electrical supply is being delivered to the patient’s heart to supplement the natural electrical activity of the heart muscle. The implant of a pacemaker is intended for the treatment of a slow heart beat either due to a worn out battery of a previously implanted pacemaker or a malfunction of the conduction system within the heart muscle. As the technology of pacemakers has substantially evolved, the indication for pacemaker implant has also been expanded to include both specific type of rapid heartbeat and weak heart muscle associated with certain electrical conduction abnormalities.

Pacemaker insertion is an in-hospital procedure that requires sedation or general anesthesia depending on the type of pacemaker implanted and a one-day hospital stay. The procedure requires an insertion of one to three electrical wires and a battery. The preferred location of a pacemaker is over the left or right upper chest area, below the collarbone. In some special situations the battery may be inserted in the abdominal wall or directly inside the lower right heart chamber. The wire or wires are inserted in the vein and are threaded into the right heart chambers and positioned according to the hearts need. In the one-wire system (single chamber pacemaker), the wire is positioned in the lower right heart chamber. The wires are positioned in the right upper and lower heart chambers in the two-wire system (dual chamber pacemaker). A third additional wire is positioned into a vein that drains into the lower right heart chamber and placed behind the lower left heart chamber in the three-wire system (biventricular pacemaker). This type of pacemaker is indicated in a patient with a weak heart muscle and an electrical activity abnormality. Your physician will determine the correct pacemaker that is indicated for your condition.

The pacemaker is normally checked with a computer scanner and a minor programming adjustment may be done before discharge the next morning. The patient will receive complete instructions regarding activity, incision care, pacemaker safety and follow-up appointment. Pacemakers will be monitored remotely and a device will be provided for all new implants to be kept plugged in at home close to the patient's bed. This will allow for any detected abnormality in heart rhythm or any pacemaker malfunction to be transmitted to your physician's office.

Instructions Prior to Insertion of a Pacemaker:

Preliminary blood test and EKG is usually requested prior to pacemaker insertion.

If you are currently taking Coumadin or other blood thinners such Eliquis and Xarelto, they will need to be stopped up to 3 days before the procedure. Instructions will be provided to you by our office staff.

If you are diabetic, cut insulin dose and/or diabetic pill in half the evening before the test. Do not take any insulin or diabetic pills the morning of your test. If you are unsure about the instruction, please call our offices.

Do not eat or drink after midnight the evening before your test.

Do not take all your normal morning medications the day of your test.

Bring an up-to-date list of your medications with you on the day of your test.

An Implantable Cardiovertor Defibrillator is a device that is implanted into a patient to detect a serious life-threatening heart rhythm and deliver an electrical shock to correct it. ICD insertion is an in-hospital procedure that requires sedation or general anesthesia and a one-day hospital stay. The procedure requires an insertion of one to three electrical wires and an ICD generator. The device is slightly larger than a regular pacemaker unit and is also categorized similar to the pacemaker as a single chamber (one wire system), dual chamber (two wire system) and biventricular AICD (three wire system).

ICD implantation is usually indicated for a patient with a spontaneous or catheter induced life threatening heart rhythm. The indication of ICD implantation has recently been expanded for preventive treatment for patients who are at high risk of developing these serious life threatening heart rhythms. These include patients with markedly decreased heart function that is not corrected with medications or surgery. The usual threshold for IDC implantation is when the left side ejection fraction is less than 35% (approximately half of the normal heart function).

The ICD is normally checked with a computer scanner and a minor programming adjustment may be done before discharge the next morning. The patient will receive complete instructions regarding activity, incision care, ICD safety and follow-up appointment. Defibrillator will be monitored remotely and a device will be provided for all new implants to be kept plugged in at home close to the patient's bed. This will allow for any detected abnormality in heart rhythm or any defibrillator malfunction to be transmitted to your physician's office.

Instructions Prior to Insertion of an ICD:

Preliminary blood test and EKG is usually requested prior to ICD insertion.

If you are currently taking Coumadin or other blood thinners such Eliquis and Xarelto, they will need to be stopped up to 3 days before the procedure. Instructions will be provided to you by our office staff.

If you are diabetic, cut insulin dose and/or diabetic pill in half the evening before the test. Do not take any insulin or diabetic pills the morning of your test. If you are unsure about the instruction, please call our offices.

Do not eat or drink after midnight the evening before your test.

Do not take all your normal morning medications the day of your test.

Bring an up-to-date list of your medications with you on the day of your test.

TAVR is a procedure to replace an aortic valve that is narrowed and doesn't open fully. The aortic valve is located between the left lower heart chamber and the body's main artery. Narrowing of the aortic valve is called aortic valve stenosis. The valve problem blocks or slows blood flow from the heart to the body.

TAVR is minimally invasive, which does not require incisions like the traditional replacement using open-heart valve surgery. It is an option for people who are at increased risk heart surgery to replace the aortic valve. TAVR can help reduce chest pain, shortness of breath and other symptoms of aortic valve stenosis.

Transcatheter aortic valve replacement also may be called transcatheter aortic valve implantation (TAVI). The decision to have TAVR is made after discussing each case with a team of heart doctors and heart surgeons. The team works together to determine the best treatment option for you. Extensive evaluation is usually required including heart catheterization and comprehensive CT scan. 

The procedure is usually done through groin access. In some cases where leg arteries are not suitable, the implant can be perform through the neck (carotid) or arm approach. It is done under sedation or general anesthesia. Patients usually go home the next day. They will need be on some blood thinners afterwards. Periodic surveillance via echocardiogram will need to be performed after implant.

Atrial fibrillation is a common heart rhythm disorder that causes the blood to become stagnant in the upper heart chambers esp. in the left atrial appendage (LAA). Blood thinners (anticoagulants) are usually prescribed to reduce the risk of stroke associated with atrial fibrillation. Life-long medication to reduce stroke risk is not an option for many patients.

For those patients who are either contraindicated for blood thinners or wish to discontinue use, placement of LAA occluder is a viable option to reduce their risk of stroke without requiring these patients to endure the challenges of oral anticoagulants (OACs).

The implant is performed through the groin under anesthesia with ultrasound guidance. patients usually leave the hospital the following day. Follow up transesophageal echo ( TEE) is usually performed about 6 weeks later to ensure full appendage closure, then blood thinners can be permanently reduced without increased long term risk of stroke even if atrial fibrillation persist.