What is left atrial appendage occlusion?
The left atrial appendage is a small pouch on the side of the left upper chamber of the heart. In atrial fibrillation the chamber does not contract properly, blood becomes sluggish in this pouch and clots can form; if a clot breaks free it travels to the brain and causes a stroke. Left atrial appendage occlusion is a procedure in which a small, self-expanding plug is placed at the mouth of the pouch so that blood can no longer enter it. Over a few weeks the body covers the plug with its own lining and the pouch is permanently sealed off.
Why is it done?
Blood-thinning tablets are the usual way of preventing stroke in atrial fibrillation, but some patients cannot take them safely, for example after serious bleeding from the stomach or the brain, or because of a high risk of falls. For these patients closing the appendage offers similar protection against stroke without the need for long-term blood thinning. It is not a treatment for atrial fibrillation itself: your heart rhythm and heart rate medication continue as before.
What happens on the day?
You come in fasting and stay in hospital for a night. The procedure is done in the catheterisation laboratory under sedation or general anaesthesia. A catheter is passed from a vein in the groin to the right upper chamber of the heart, and a small controlled opening is made in the wall between the two upper chambers so that the left side can be reached. Using X-ray and ultrasound of the heart from the gullet, the appendage is measured, the correct size of plug is chosen and it is positioned at the mouth of the pouch. Before the device is released, careful checks confirm that it is stable, correctly placed and not leaking. The procedure usually takes one to two hours.
What to expect afterwards
You lie flat for a few hours to allow the groin puncture to seal and stay overnight for monitoring. Most people feel normal the next day, with only some bruising and tenderness in the groin. You should avoid heavy lifting and strenuous exercise for about a week. For the first few weeks to months you will need blood-thinning or antiplatelet medication while the device becomes covered by the body lining, and the exact plan is decided for you individually. An ultrasound of the heart, and sometimes a scan through the gullet, is done at around six to twelve weeks to confirm that the appendage is sealed, after which long-term blood thinning can usually be stopped. Tell any doctor or dentist that you have the device, and take antibiotic cover before dental work if advised.
Possible complications
Most procedures are uneventful, but this is an implant inside the heart and there are risks. The most common are bruising or bleeding at the groin. More serious but uncommon problems include bleeding into the sac around the heart, which may need to be drained; the device moving out of position or, very rarely, breaking free and needing removal; a clot forming on the surface of the device; stroke; injury to a blood vessel; and, rarely, death. There may also be a small remaining gap around the device, which is monitored on the follow-up scan. Anaesthesia and the gullet ultrasound carry their own small risks, such as a sore throat. Your cardiologist will discuss your own risk of stroke, of bleeding and of the procedure so that you can weigh them together.
This information does not replace a consultation. Please discuss your own risks and options with your cardiologist.