The left atrial appendage (LAA) is a pouch-like sac in the wall of the left atrium (top left chamber of the heart). See Diagram. It’s unknown if the LAA performs any function. Because the LAA is a small pouch, blood can collect there and can form clots in the appendage and left atria. The blood clots that are formed in the left atrial appendage can be pumped out of the heart and can cause a stroke.
When Atrial Fibrillation (AF) occurs, there are several areas in the top chambers of the heart that are firing impulses at the same time. The AV Node will not allow all the electrical impulses through. There is a lack of communication between the atria and ventricles in the heart, and they work independently of each other.
Taking blood thinners, such as Warfarin, reduces the risk of stroke in patients with atrial fibrillation. Taking blood thinners can come with risks of bleeding. Warfarin also requires frequent monitoring of the blood to measure if the warfarin is working.
There are now new medications are that are available for patients with atrial fibrillation. These medications do not require frequent blood draws like Warfarin. However, there is still a risk of bleeding with these medications. Some patients cannot tolerate these medications.
A Left Atrial Appendage Closure procedure is performed under a general anaesthetic. It means that you will be asleep during the procedure. When you are asleep, a test called a transesophageal echocardiogram is be carried out. Transesophageal Echo is an ultrasound with a small probe. The ultrasound probe is placed down the oesophagus, the tube that connects the mouth to the stomach. It is right behind the heart, and therefore, the cardiologist can then see the structures of the heart. This test measures the size of the hole and helps with the placement of the closure device.
During the catheterisation, the Cardiologist will place a small plastic tube in the blood vessel in the top of the leg or the groin. A catheter is threaded through the vessel with a soft tip wire to prevent any tears in the blood vessel. A catheter is threaded through the right atrium to the left side of the heart. The correct size Closure Device is inserted into the opening of the Left Atrial Appendage. This seals off the Appendage and keeps it from releasing clots.
Once the device is in place, and we are happy with the position of the device, the catheter is removed, and the puncture in your leg is closed with pressure and a small dressing.
You will need to take things easy over the next couple of days. There will be a small dressing over the site, and it is important to keep it clean and dry. The nurse on the ward will put a new dressing over the area on the day of discharge. There may be a small bruise, and the site may even be tender over the next couple of days. An ice pack may be useful, and your doctor may prescribe a mild pain killer.
You will need to take a blood thinner for six months after the procedure. This will help to prevent small blood clots from forming around the device. You will be given a prescription for a blood thinner before you are discharged home from the hospital.
You may need to take antibiotics before and after dental treatments for six months after the procedure. These drugs help prevent a heart infection called infectious endocarditis.
Your will receive an appointment for follow-up about 3 months after the procedure.