Percutaneous Left Atrial Appendage Closure
(Left Atrial Appendage Occlusion)
The left atrial appendage (LAA) is a small pouch in the left atrium, the top chamber of the heart. The function of the LAA is not known.
A percutaneous left atrial appendage closure (LAAC) uses a device or sutures to seal the LAA.
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Reasons for Procedure
Atrial fibrillation is an abnormal beating of the top part of the heart (atria). People with atrial fibrillation have a high risk of blood clots and stroke. The abnormal beat makes it harder for blood to clear out of the atria and blood pools in the LAA. Blood clots can develop in the pooled blood, can leave the heart and travel to the brain where it can cause a stroke. Medications are a common option to reduce the risk of blood clots and stroke, but not all people can tolerate the medication or its side effects.
An LAAC may be an alternative for people with atrial fibrillation who cannot take anticoagulant medications. LAAC closes off the left atrial appendage to prevent blood from pooling in the area. Most blood clots in the heart develop in the left atrial appendage. Sealing off the area will decrease the chance of clots and stroke.
Problems from the procedure are rare, but all procedures have some risk. Your doctor will review potential problems, like:
- Damage to the heart tissue or blood vessels that are involved
- Device can slip out of place
- Inflammation of the sac around the heart
Before your procedure, talk to your doctor about ways to manage factors that may increase your risk of complications such as:
- Chronic disease such as diabetes or obesity
What to Expect
Prior to Procedure
Your doctor may do the following:
- Physical exam, including blood and urine tests
- Chest x-ray
- ECG —a test that records the electrical activity of the heart
- Transesophageal echocardiography (TEE)—a test that takes images of your heart, may be needed to help choose the size of the device that will be used
In the days leading up to your procedure:
- Talk to your doctor about your medications, including over-the-counter medications. You may be asked to stop taking some medications up to 1 week before the procedure.
- Arrange for someone to drive you home from the hospital and help you out at home.
- Eat a light meal the night before. Do not eat or drink anything after midnight.
- Avoid smoking.
Local or general anesthesia may be used. Local anesthesia will numb where the catheter is inserted. With general anesthesia, you will be asleep during the procedure. You may also be given a sedative before the procedure to help you relax.
Description of the Procedure
This method only needs a small incision which can decrease risks and recovery time compared to open procedures with large incisions.
A small incision will be made over a vein in the groin. A tube called a catheter will be placed into the vein and passed through blood vessels to the heart. An imaging machine will help the doctor see exactly where the catheter is in the body.
Tools or devices will be passed through the catheter to complete the work. The exact steps will depend on the type of LAAC. Some options include:
- Placing a device in the LAA to block off the area. The device will also catch any blood clots that already exist before they pass out of the heart. Over time, tissue will form over the filter to seal it.
- The area is closed off with wire and stitches to keep blood out.
Once the procedure is done the catheter(s) will be removed. Pressure will be applied to the incision to stop bleeding and a bandage will be placed over the area.
How Long Will It Take?
Will It Hurt?
Anesthesia will prevent pain during the procedure. You will have some pain in the chest and at the insertion site after the procedure. Your doctor will recommend medications to help manage the pain.
At the Care Center
Right after the procedure, a weight will be placed over your leg for a time to help the vein close. The staff will check your vital signs and monitor you for any bleeding.
Images will be taken to ensure the device is correctly placed.
During your stay, the hospital staff will take steps to reduce your chance of infection such as:
- Washing their hands
- Wearing gloves or masks
There are also steps you can take to reduce your chance of infection such as:
- Washing your hands often and reminding visitors and healthcare providers to do the same
- Reminding your healthcare providers to wear gloves or masks
Most will return to normal activities within the first few days. Follow-up visits will be needed starting at 45 days to make sure the area has sealed off. Once the area is sealed, anticoagulant medication can be stopped. Most will be able to stop medication by 1 year. Yearly tests will be needed to make sure the closure device is in place.
Call Your Doctor
It is important to monitor your recovery. Alert your doctor to any problems. If any of the following occur, call your doctor:
- Shortness of breath
- Numbness, coldness, pain, bleeding, swelling, or redness where the catheter was inserted
- Chest pain
Call for emergency medical services right away if you notice any of the following symptoms of a stroke:
- Weakness or numbness of the face, arm, or leg, especially on 1 side of the body
- Trouble speaking or understanding
- Trouble seeing in 1 or both eyes
- Lightheadedness, trouble walking, loss of balance, or coordination
- Severe headache with no known cause
If you think you have an emergency, call for emergency medical services right away.
American Heart Association
National Heart, Lung, and Blood Institute
Canadian Heart Rhythm Society
Heart and Stroke Foundation of Canada
Answers to common questions about left atrial appendage closure. Seconds Count website. Available at: http://www.scai.org/SecondsCount/Resources/Detail.aspx?cid=4ae996d0-972c-4f73-9f59-fe5d51fd2b9a#.Wh2Uu1WnFxB. Accessed November 28, 2017.
Benefits and risks of left atrial appendage closure. Seconds Count website. Available at: http://www.secondscount.org/heart-condition-centers/info-detail-2/benefits-risks-of-left-atrial-appendage-closure#.Wh2U9lWnFxB. Accessed November 28, 2017.
Left atrial appendage and closure. Cleveland Clinic website. Available at: https://my.clevelandclinic.org/health/articles/left-atrial-appendage-closure. Updated June 2017. Accessed November 28, 2017.
Left atrial appendage closure (LAAC). Seconds Count website. Available at: http://www.secondscount.org/treatments/left-atrial-appendage-closure-laac#.Wh2WHlWnFxD. Accessed November 28, 2017.
Shehata M, Yeo WL, Kar S. Device interventions for stroke prevention in atrial fibrillation. Circulation. 2014;129:e360-e362. Available at: http://circ.ahajournals.org/content/circulationaha/129/9/e360.full.pdf.
Watchman procedure. UPMC Pinnacle website. Available at: https://www.pinnaclehealth.org/services-and-resources/our-services/heart-and-vascular-care/cardiac-services/atrial-fibrillation-program/watchman-procedures. Accessed November 28, 2017.
Last reviewed November 2018 by EBSCO Medical Review Board Michael J. Fucci, DO, FACC Last Updated: 2/8/2017