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Percutaneous Left Atrial Appendage Closure

(Left Atrial Appendage Occlusion)

Left A-tree-ull App-en-dej Oc-clu-shun

Definition

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.

Anatomy of the Heart

Copyright © Nucleus Medical Media, Inc.

Reasons for Procedure    TOP

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.

Possible Complications     TOP

Problems from the procedure are rare, but all procedures have some risk. Your doctor will review potential problems, like:

  • Stroke
  • Damage to the heart tissue or blood vessels that are involved
  • Bleeding
  • 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:

  • Smoking
  • Drinking
  • Chronic disease such as diabetes or obesity

What to Expect    TOP

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.

Anesthesia

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    TOP

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?    TOP

1-2 hours

Will It Hurt?    TOP

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.

Post-procedure Care     TOP

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

At Home

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     TOP

It is important to monitor your recovery. Alert your doctor to any problems. If any of the following occur, call your doctor:

  • Lightheadedness
  • Fever
  • 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
  • Confusion
  • 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.

RESOURCES:

American Heart Association
http://www.heart.org
National Heart, Lung, and Blood Institute
https://www.nhlbi.nih.gov

CANADIAN RESOURCES:

Canadian Heart Rhythm Society
http://www.chrsonline.ca
Heart and Stroke Foundation of Canada
http://www.heartandstroke.ca

References:

Answers to common questions about left atrial appendage closure. Seconds Count website. Available at:
...(Click grey area to select URL)
Accessed November 28, 2017.
Benefits and risks of left atrial appendage closure. Seconds Count website. Available at:
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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:
...(Click grey area to select URL)
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:
...(Click grey area to select URL)
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 2017 by EBSCO Medical Review Board Michael J. Fucci, DO, FACC
Last Updated: 2/8/2017

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