What is Left Atrial Appendage Closure (LAA) Device?

Left atrial appendage closure is a surgical or minimally invasive procedure to seal off your left atrial appendage (LAA), a small sac in the muscle wall of your left atrium (top left chamber of your heart). Removing it or closing it off can reduce your risk of stroke and eliminate the need to take blood-thinning medication.

Studies have shown that, among people with atrial fibrillation who don’t have valve disease, most of the blood clots that happen in the left atrium start in the LAA.

It’s unclear what function, if any, the left atrial appendage performs. Your heart can continue to do its job with a closed left atrial appendage.

Normal hearts contract with each heartbeat, and the blood in your left atrium and LAA is squeezed out of your left atrium into your left ventricle (bottom left chamber of the heart).

In someone who has atrial fibrillation, the electrical impulses that control the heartbeat don’t travel in an orderly way through your heart. Instead, many impulses begin at the same time and spread through the atria. The fast and chaotic impulses don’t give your atria time to contract and/or effectively squeeze blood into your ventricles.

Because the left atrial appendage is a little pouch, blood collects there and can form clots in the LAA and atria. When your heart pumps out blood clots, they can cause a stroke. People with atrial fibrillation are three to five times more likely to have a stroke than the general population.

Types of left atrial appendage closure devices

• Devices that block the left atrial appendage’s opening to keep blood clots that form in your LAA from going into your bloodstream: WATCHMAN, Amulet, WaveCrest.
• Devices that clamp the base of the LAA to close it off: Disclosure: Cleveland Clinic has the potential to receive a royalty payment as a result of the sale of this clip.
• Devices that use a band or suture loop to close off your LAA: Lariat, Sierra.

Who needs to have left atrial appendage closure?

If you’re at risk of developing blood clots in your left atrium/left atrial appendage, your healthcare provider may recommend a procedure to seal off your LAA. This is an alternative to taking a blood thinner like warfarin (Coumadin or Jantoven) to reduce your risk of stroke from atrial fibrillation.

Many people have concerns about, or dislike, taking warfarin. Some of the reasons for this are:

• Frequent blood draws are needed to measure your international normalized ratio (INR), or clotting time. The tests are needed to make sure you’re taking the right amount of medication.
• You need to limit certain foods you eat that contain vitamin K.
• The risk of bleeding is higher while taking warfarin.
• Some people don’t tolerate warfarin or have trouble maintaining a normal clotting time.

Other medications — dabigatran and rivaroxaban — are available for people with atrial fibrillation who don’t have heart valve disease. However, some people have concerns and problems with these medications, such as:

• People who can’t take anticoagulants can’t tolerate these medications.
• Some people are concerned about the cost of the medication.
• These medications also increase the risk of bleeding.

What does left atrial appendage closure treat?

LAA closure reduces the stroke risk associated with atrial fibrillation. But, it doesn’t treat the AFib itself. Left atrial appendage closure can benefit people who need heart surgery and also have atrial fibrillation. The procedure is also helpful for those who have atrial fibrillation (but no other problems that require heart surgery) and choose to have a Maze procedure for atrial fibrillation.

How common are left atrial appendage closure procedures?

Researchers who looked at more than 10,000 cardiac surgery records found that 37% of people had a left atrial appendage closure during their surgery.

More than 150,000 people have received the WATCHMAN device that blocks the left atrial appendage’s opening.

What happens after left atrial appendage closure?

After your surgery or minimally invasive procedure, you may:

• Stay in the ICU for 1 day and one day in the ward, followed by discharge.
• Have a transesophageal echo (TEE) within 48 hours of your procedure.

RISKS / BENEFITS

What are the advantages of left atrial appendage closure?

People who get a left atrial appendage closure can:

• Reduce their risk of stroke.
• Stop taking blood thinners.
• Have the procedure done during heart surgery for another issue.
• Have a minimally invasive procedure for a left atrial appendage closure device.