Left Atrial Appendage Closure

Left atrial appendage closure is a procedure which closes off the opening of your left atrial appendage.

What is a left atrial appendage closure?

Left atrial appendage closure is a procedure which closes off the opening of your left atrial appendage. Your left atrial appendage is a small pouch, shaped like a windsock, found in the top left of your heart (the left atrium). Like your appendix, your left atrial appendage doesn’t really have a clear role to play in your body.

This image below shows a left atrial appendage closure

Why do I need a left atrial appendage closure?

Your doctor may recommend a left atrial appendage closure procedure if you have a disease known as atrial fibrillation - which occurs when your heart’s electrical system is disturbed and your heartbeat becomes irregular.

As your heart contracts with each heartbeat, blood is squeezed out of the left atrium and into the left ventricle (bottom left of your heart). If you have atrial fibrillation, blood can’t be squeezed out of your left atrium effectively, and can therefore collect in your left atrial appendage and increase your chances of a stroke.

Blood thinning medications are a common treatment for atrial fibrillation but they aren’t suitable for everyone. If you can’t take medication, your doctor will recommend surgery to close the opening of your left atrial appendage.

What are the risks of having a left atrial appendage closure?

As with any surgery, there are some risks associated with a left atrial appendage closure procedure. Some of these can include:

  • Damage to structures in the heart
  • Incomplete closure of the left atrial appendage
  • Device becoming dislodged
  • Blood clots forming on the device
  • Allergic reaction to the device and medications
  • Irregular heartbeat, called arrhythmia
  • Bruising
  • Bleeding
  • Infection
  • Stroke
  • Death from this procedure is rare

Your doctor will explain the risks to you in detail before you agree to the surgery - and you’re also encouraged to discuss any questions or concerns with your medical team. Your doctor will ask you to sign a consent form before you have the surgery.

How do I prepare for a left atrial appendage closure?

You will prepare for your left atrial appendage closure by:

  • Having a Transoesophageal Echocardiogram (TOE) - your doctor will organise to take ultrasound pictures of your heart to make sure there are no clots before your surgery commences
  • Asking your doctor about taking your usual medications - especially if you take medication for diabetes or blood thinning medications
  • Avoiding eating or drinking – as well as smoking and drinking alcohol - at least six hours before the procedure begins

Before your procedure begins, you’ll be asked to remove any jewellery and put on a hospital gown.

What happens during a left atrial appendage closure?

There are two options for the left atrial appendage closure procedure: percutaneous and surgery.

Percutaneous procedure

Percutaneous repair means your left atrial appendage can be closed through your skin without requiring surgery. The procedure takes place in a cath lab, and you’ll will be connected to heart monitors throughout the procedure. During the percutaneous procedure:

  • A cannula will be put in your arm to give you medication
  • A local anaesthetic to numb the area - or a general anaesthetic may be given - so you don’t feel any discomfort
  • A special catheter is gently inserted in your groin and guided slowly up to your heart across the wall that separates the right and left side of your heart
  • Using X-rays, X-ray dye and echocardiograms, a device is then positioned and expanded at the opening of the left atrial appendage (this acts like a seal or “plug” and keeps clots from being released)
  • The catheter is removed and the device stays in. Over time a thin layer of tissue will grow over the surface of the device

If you have atrial fibrillation and are already having heart surgery, your doctor may recommend surgery.

Surgical procedure

If you have atrial fibrillation and are already having heart surgery, your doctor may recommend surgery to close your left atrial appendage. Your surgery will take place in a hospital operating theatre. You will be taken to the operating room on a trolley or wheelchair and asked to lie on a narrow table. The procedure is performed under general anaesthetic, which means you will be given medications before your surgery to relax and make you fall asleep.

  • You will be given medication to put you to sleep
  • Your doctor will make an incision in your chest
  • Your doctor will remove the left atrial appendage and sew or use a special clip to close the opening

What happens after a left atrial appendage closure?

After your procedure, you’ll be transferred to the cardiac ward for monitoring and observation. There, your doctor will be able to determine how long you need to be in hospital for and if you need to take any blood thinning medications. You might also need to have follow-up TOEs to check the closure.

Remember that your team are dedicated to ensuring the best possible outcome for you, and they will be there to support your recovery every step of the way. Before you go home, you’ll be given detailed instructions on how to recover well and return to good health - and it’s very important that you follow this advice. If you continue to feel any signs or symptoms that make you feel concerned, make an appointment with your doctor.

 

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