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by Scholten A

Percutaneous Left Atrial Appendage Closure

(Left Atrial Appendage Occlusion)

Definition

There is a small pouch in the left atrium (top left chamber) of the heart. This pouch is called the left atrial appendage (LAA).
A percutaneous left atrial appendage closure (LAAC) is a procedure to seal the LAA. The seal is done with a device or sutures. It prevents blood from pooling in the atrium.
Anatomy of the Heart
IMAGE
Copyright © Nucleus Medical Media, Inc.

Reasons for Procedure

Atrial fibrillation is an abnormal heartbeat. For people with this condition, an LAAC may be done to prevent:
An LAAC is often done for those who cannot take blood thinner medicine.

Possible Complications

Problems are rare, but all procedures have some risk. The doctor will go over some problems that could happen, such as:
  • Bleeding
  • Problems from anesthesia, such as wheezing or sore throat
  • Stroke
  • Damage to organs or structures
  • Infection
  • Device slips out of place
  • Inflammation of the sac around the heart
Things that may raise the risk of problems are::
  • Smoking
  • Drinking alcohol
  • Chronic disease such as diabetes or obesity

What to Expect

Prior to Procedure

The surgical team may meet with you to talk about:
  • Anesthesia options
  • Any allergies you may have
  • Current medicines, herbs, and supplements that you take and whether you need to stop taking them before surgery
  • Fasting before surgery, such as avoiding food or drink after midnight the night before
  • Whether you need a ride to and from surgery
  • Tests that will need to be done before surgery—such as imaging

Anesthesia

The doctor will give general anesthesia. You will be asleep.

Description of the Procedure

A small incision will be made over a vein in the groin. A tube will be placed into the vein. The tube will be passed through blood vessels to the heart. An imaging machine will help the doctor see where the tube is in the body.
Tools or devices will be passed through the tube to complete the work. The exact steps will depend on the type of LAAC. Some options are:
  • Placing a device in the LAA to block off the area. The device will also catch any blood clots 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 tubes(s) will be removed. Pressure will be applied to the incision to stop bleeding. A bandage will be placed over the area.

How Long Will It Take?

1 to 2 hours

Will It Hurt?

There will be some pain in the chest and insertion site after the procedure. Medicines and home care will help.

Average Hospital Stay

Most can go home the same day as the procedure.

Post-procedure Care

At the Care Center
During your stay, the hospital staff will take steps to lower your risk of infection such as:
  • Washing their hands
  • Wearing gloves or masks
There are also steps you can take to lower your risk of infection such as:
  • Washing your hands often and reminding visitors and staff to do the same
  • Reminding staff to wear gloves or masks
At Home
Most can return to normal activities within the first few days.

Call Your Doctor

Call your doctor if you are not getting better or you have:
  • Signs of infection such as fever or chills
  • Redness, swelling, excess bleeding, numbness, or coldness at the insertion site
  • Lightheadedness
  • Problems breathing
  • Chest pain
Call for medical help right away if you have:
  • Weakness or numbness of the face, arm, or leg
  • Confusion
  • Problems speaking or understanding
  • Problems seeing in one or both eyes
  • Lightheadedness, problems walking, or loss of balance or coordination
  • Severe headache
If you think you have an emergency, call for medical help 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

Atrial fibrillation. EBSCO DynaMed website. Available at: https://www.dynamed.com/condition/atrial-fibrillation. Accessed July 21, 2021.
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#.YPh0zI5Kg2y . Accessed July 21, 2021.
Gianni C, Anannab A, et al. Closure of the left atrial appendage using percutaneous transcatheter occlusion devices. J Cardiovasc Electrophysiol. 2020;31(8):2179-2186.
Left atrial appendage and closure. Cleveland Clinic website. Available at: https://my.clevelandclinic.org/health/treatments/17167-left-atrial-appendage--closure. Accessed July 21, 2021.
Left atrial appendage closure (LAAC). Seconds Count website. Available at: http://www.secondscount.org/treatments/left-atrial-appendage-closure-laac#.YPhz-Y5Kg2z. Accessed July 20, 2021.
Left atrial appendage occlusion/Watchman procedure. UPMC website. Available at: https://www.upmc.com/services/south-central-pa/heart-vascular/conditions-services/heart-rhythm-disorders/treatments-services/watchman. Accessed July 20, 2021.

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