Left Atrial Appendage Closure

What is Left Atrial Appendage Closure?

Left atrial appendage closure is a catheter-based procedure that seals off a small pouch attached to the left upper chamber of the heart. That pouch is the left atrial appendage, often shortened to LAA. It serves no essential function in adults, but atrial fibrillation changes that. In this irregular rhythm the upper chambers quiver rather than contract, so blood can pool inside the pouch and form a clot. A clot that escapes can travel to the brain and cause a stroke. Closing the pouch removes the most common site where these clots form. The procedure is done through a vein in the leg, so there is no chest incision. A small self-expanding implant is guided to the mouth of the appendage and released. Heart tissue then gradually grows over it. The goal is to lower stroke risk in people who cannot safely stay on long-term blood thinning medication.

Why Dr. Nanavati may recommend this

Atrial fibrillation substantially raises the risk of stroke, which is why blood thinning medication is the standard treatment. The American Heart Association explains atrial fibrillation and its link to stroke. The National Heart, Lung, and Blood Institute reviews how it is treated.

Some people, however, cannot take anticoagulants safely. LAA closure exists for them.

Dr. Nanavati may discuss this procedure if you have:

• Atrial fibrillation not caused by a heart valve problem, with a stroke risk high enough to warrant treatment.
• A history of serious bleeding on a blood thinner, such as gastrointestinal or brain bleeding.
• A condition or occupation that makes bleeding especially dangerous, such as frequent falls.
• Anemia or a bleeding disorder that makes long-term anticoagulation impractical.
• A stroke or clot that occurred despite taking anticoagulation correctly.

This is not a treatment for the arrhythmia itself. Your heart will still be in atrial fibrillation afterward. You may still need rate or rhythm medication. We perform the procedure at an affiliated hospital rather than in our office. The decision involves a careful weighing of your bleeding risk against your stroke risk.

How to prepare

• Expect imaging beforehand, usually a transesophageal echocardiogram or a CT scan. It measures the appendage and confirms no clot is already present.
• Expect blood tests, an electrocardiogram, and a kidney function check.
• Follow the specific instructions about your blood thinner. Some are continued and some are adjusted. Never decide this on your own.
• Do not eat or drink after midnight, or as directed. Essential medications may be taken with a small sip of water.
• Report allergies to contrast dye, iodine, latex, anesthesia, or any medication.
• Arrange for an adult to drive you home, and plan for an overnight hospital stay.
• Pack a small bag with your medication list, insurance information, and comfortable clothing.
• Tell the team about sleep apnea, breathing problems, or previous difficulty with anesthesia.

What happens during the procedure

You lie on a table in a catheterization laboratory. Monitors track your heart rhythm, blood pressure, and oxygen. General anesthesia is commonly used, so most people are asleep and remember nothing.

The team cleans, drapes, and numbs the skin over a vein in the groin. A sheath is placed into the vein. Thin catheters then travel up to the right side of the heart. Live X-ray images guide every step.

Reaching the left atrium takes one more step. A small controlled puncture is made in the thin wall between the two upper chambers. This is a routine step in many heart procedures. The opening typically closes on its own over time.

Ultrasound imaging from inside the esophagus or the heart shows the exact size and shape of the appendage. Contrast dye adds further detail. The implant is selected to match, then advanced in a collapsed state and positioned at the mouth of the pouch.

Before it is released, the team tugs on it gently and re-images the appendage. This confirms the implant is stable, correctly sized, and sealing well. Only then is it detached. The catheters are removed, and pressure is applied at the groin.

The procedure usually takes one to two hours.

Recovery and results

You wake in a recovery area and lie flat for several hours so the groin site can seal. Most people stay in the hospital overnight and go home the next day. Mild groin soreness and bruising are common for a few days. A sore throat from the breathing tube or ultrasound probe is also common.

Avoid heavy lifting, straining, and strenuous activity for about a week, and keep the site clean and dry. Many people return to light activity and desk work within a few days.

Blood thinning medication usually continues for a period after the implant is placed. That period is commonly around 45 days, while tissue grows over the device. Follow-up imaging is then done to confirm the appendage is sealed. If it is, the anticoagulant is often stopped. Antiplatelet medication such as aspirin takes its place, sometimes with a second agent for a while. Your exact medication plan depends on the imaging result and your bleeding history, and you must follow it precisely.

You will need regular follow-up with your cardiologist afterward.

Risks and safety

This is a real heart procedure, and the risks deserve straightforward description. For most candidates the risk of a serious complication is low. It is not zero.

One of the most significant risks is bleeding into the sac around the heart. This is called pericardial effusion, and it sometimes needs to be drained. Other risks include bleeding or injury at the groin access site. Stroke can occur during or shortly after the procedure. The device can also move out of position, which is rare but may require removal.

A clot can occasionally form on the surface of the implant before tissue covers it. That is why the medication schedule and follow-up imaging matter so much.

General anesthesia carries its own small risks. Contrast dye can affect kidney function or cause an allergic reaction.

Tell any dentist or surgeon about the implant before procedures. Preventive antibiotics may be advised for a period. Call the office for fever, groin swelling, or new bleeding. Call 911 for chest pain, sudden weakness, difficulty speaking, or loss of vision.

Related services and conditions

• Atrial fibrillation, the reason this procedure is considered.
• Arrhythmias and how they are evaluated.
• Holter monitoring to assess rhythm and heart rate.
• About Dr. Vimal Nanavati, interventional cardiologist.