Left Atrial Appendage Closure Procedure

Overview

A left atrial appendage closure, also known as an LAA or LAAC, is a minimally invasive procedure, typically performed to reduce the risk of stroke associated with atrial fibrillation (AF). Atrial fibrillation is a type of arrhythmia.

The left atrial appendage (LAA) is a muscle in the wall of the upper left chamber of the heart (atrium). 

Candidates for left atrial appendage closure procedure

While a left atrial appendage closure can reduce the risk of stroke for some people, it is not right for everyone. Your Bon Secours doctor and care team will discuss the procedure’s benefits and risks and help you determine if your health insurance will cover the procedure.
People who cannot take blood-thinning medications to prevent blood clots caused by A Fib are potential candidates for an LAA. In some people, blood thinners cause new bleeding or are challenging to regulate, while in others on blood thinners still have problems with blood clots. 

Preparing for a left atrial appendage closure procedure

In preparation for a left atrial appendage closure procedure, your doctor will order a transesophageal echocardiogram to take ultrasound images of the heart to ensure there are no clots before the surgery.

Let your doctor know what medications you are taking, especially if you take blood-thinning medications or medications for diabetes. Patients taking certain types of diabetes medications will need to stop taking them three days before surgery.

Do not eat, drink, smoke, or consume alcohol six hours before the procedure. 

Before your procedure begins, you will be asked to remove any jewelry and put on a hospital gown.

Expectations during a left atrial appendage closure procedure

There are several methods and devices used for closing the left atrial appendage. Your Bon Secours doctor will determine which option is best for your case. Because there are risks associated with the surgery, your doctor will reserve this procedure for patients whose risk of the procedure is less than the risk of having a stroke or bleeding without the LAA.

The most common left atrial appendage closure approaches are using the WATCHMAN device or AtriClip.

WATCHMAN

• The FDA has approved the Watchman device to help reduce the risk of thromboembolism in patients with nonvalvular atrial fibrillation who fall into the following categories:
• Patients who are at higher risk of stroke and systemic embolism where anticoagulation therapy is recommended.
• Patients who are approved to take warfarin by their doctor.
• Patients who need an alternative to taking warfarin and have taken into consideration the safety and effectiveness of the device compared to warfarin. 

The WATCHMAN Device is implanted by a specialized cardiologist called an electrophysiologist in an electrophysiology (EP) lab. General anesthesia may be necessary to put you to sleep during the procedure. The device is placed in the LAA opening to seal it off and prevent it from releasing clots.

AtriClip

An AtriClip is a device that circles the outside of the left atrial appendage, preventing blood flow there. Your Mercy Health cardiac surgeon will perform open-heart surgery or minimally invasive cardiac surgery to insert the AtriClip.

Recovery after a left atrial appendage closure procedure

If you had a WATCHMAN procedure, you will stay in the hospital after the procedure, and take aspirin and warfarin until a follow-up appointment, 45 days after the procedure. 

While recovery time is generally short, your doctor will instruct you to limit your activity level for a week after the procedure. Do not drive for 24 hours after the procedure. You may have some bruising at the site where the catheter was inserted.

You will need a transesophageal echocardiogram (TEE) within 48 hours after the procedure and again at the follow-up appointment at 45 days. Your doctor will give you instructions on what medications to take based on the results of your TEE. 

Once the LAA is blocked, you will need a yearly follow-up clinic appointment. 

If you had an AtriClip procedure, you will likely stay two or more days in the hospital for monitoring. Once discharged, you will be given instructions on how to care for the wound, when you can return to activity level, etc. You will not be allowed to drive for two weeks after the procedure. 

You will need to schedule a follow-up appointment 45 days after the procedure.