The left atrial appendage is a small pouch on the left atrium of the heart. In atrial fibrillation, blood can pool in this pouch and form clots that may travel to the brain and cause a stroke. The standard approach to reducing this risk is long-term anticoagulation (blood thinners). Left atrial appendage (LAA) closure is an alternative for patients who cannot tolerate or have a high bleeding risk on long-term anticoagulation.
Who might be considered
- Patients with atrial fibrillation and a moderate-to-high stroke risk
- A history of major bleeding on anticoagulation, or strong clinical reasons it cannot be continued
- Selected occupational, lifestyle, or comorbidity factors that make long-term anticoagulation impractical
The procedure
LAA closure is performed under general anaesthetic with transoesophageal echocardiography (TOE) guidance. Access is via the femoral vein, and the device is delivered across the inter-atrial septum into the LAA, where it is deployed to close the opening. The procedure usually takes around 60 to 90 minutes and most patients stay one night in hospital.
Risks
Risks include vascular access complications, pericardial effusion, device embolisation (rare), and incomplete closure requiring continued anticoagulation. After closure, a defined period of antithrombotic therapy is required, followed by long-term aspirin in most cases. Follow-up imaging is performed to confirm seal and rule out device-related thrombus.