From the Guidelines
A left atrial appendage (LAA) closure procedure is a minimally invasive treatment that reduces stroke risk in patients with atrial fibrillation who cannot take blood thinners long-term, as supported by the most recent guidelines and studies, including the 2019 AHA/ACC/HRS focused update 1.
Procedure Overview
The procedure involves inserting a small device through a catheter in the groin, guiding it to the heart to seal off the left atrial appendage (LAA), a small sac in the left atrium where blood clots commonly form during atrial fibrillation.
Key Points
- The procedure typically takes 1-2 hours under general anesthesia, with patients usually staying in the hospital overnight.
- After placement, tissue grows over the device within 45 days, permanently sealing the LAA.
- Patients typically take blood thinners like warfarin for about 45 days post-procedure, then switch to dual antiplatelet therapy (aspirin 81mg daily plus clopidogrel 75mg daily) for 4-6 months, before transitioning to aspirin alone indefinitely.
- This approach works because over 90% of stroke-causing clots in atrial fibrillation patients originate in the LAA, so blocking this area provides protection similar to blood thinners without their bleeding risks.
Recovery and Outcomes
- Recovery is relatively quick, with most patients resuming normal activities within a few days, though strenuous exercise should be avoided for about a week.
- The Watchman device, one of the most commonly used LAA closure devices, has been shown to be effective in reducing stroke risk in patients with atrial fibrillation, with a significant reduction in hemorrhagic strokes compared to warfarin, as demonstrated in the PROTECT AF and PREVAIL trials 1.
- However, it is essential to carefully select patients for this procedure, considering their individual risk factors and contraindications to oral anticoagulation, as emphasized in the 2019 AHA/ACC/HRS guidelines 1.
From the Research
Left Atrial Appendage Closure Procedure
The left atrial appendage (LAA) closure procedure is a medical intervention aimed at preventing stroke and systemic embolism in patients with atrial fibrillation (AF) [ 2 ]. This procedure involves the closure of the left atrial appendage, a small pouch in the heart where blood clots can form, increasing the risk of stroke.
Purpose and Benefits
The primary purpose of LAA closure is to reduce the risk of thromboembolism without increasing the risk of bleeding, which is a crucial strategy for patients at high risk for bleeding [ 3 ]. The benefits of LAA closure include:
- Reduced risk of stroke and systemic embolism
- Decreased bleeding risk compared to long-term anticoagulation
- Potential alternative to oral anticoagulant therapy for patients with AF
Procedure Techniques
LAA closure can be performed using various techniques, including:
- Percutaneous left atrial appendage closure (LAAC) [ 3 ]
- Minimally invasive, simplified double-layer left atrial appendage closure [ 4 ]
- Open heart surgery [ 4 ]
Devices and Outcomes
Several devices are available for LAA closure, including the Watchman device and the Amplatzer cardiac plug [ 3 ]. Studies have shown that LAA closure can be safe and effective in reducing the risk of stroke and systemic embolism [ 2 , 5 ]. However, the optimal antithrombotic treatment strategy after LAA closure remains uncertain [ 6 ].