Left Atrial Appendage Closure (LAAC)

Left atrial appendage closure (LAAC) is a medical procedure used to reduce the risk of stroke in people with atrial fibrillation (AF). AF is an irregular heartbeat that can cause blood to pool in the left atrial appendage, a small pouch in the heart, which can lead to the formation of blood clots. If a blood clot forms and travels to the brain, it can cause a stroke. The recommended treatment to reduce the risk of stroke in AF patients is to start blood thinning tablets. Left Atrial Appendage Closure is an alternative treatment that is typically recommended for people with AF who have a high risk of stroke but are unable to take blood-thinning medications or have had bleeding complications from those medications in the past.

Fig 67 LAAC

Transcatheter LAAC procedure is typically performed using a catheter that is inserted through a small incision in the groin and threaded up to the heart. Once the catheter reaches the left atrial appendage, a small device is inserted and used to seal off the appendage. This prevents blood from pooling in the appendage and reduces the risk of blood clots forming. The device remains in place permanently. Surgical Left Atrial Appendage Closure could be performed during open-heart surgery, in which the surgeon accesses the left atrial appendage and closes it off using sutures, staples, or other closure devices.

One of the most commonly used and tested transcatheter Left Atrial Appendage Closure device is called a Watchman device. The Watchman device is made of a flexible metal frame and a fabric membrane that is designed to close off the left atrial appendage. The device is inserted into the heart through a catheter and placed at the opening of the left atrial appendage. Over time, tissue grows over the device, completely sealing off the appendage.

Fig 69 LAAC
Other transcatheter LAAC devices include the Amplatzer Cardiac Plug and the Lariat suture delivery device. Each of these devices works in a slightly different way but is designed to achieve the same goal of sealing off the left atrial appendage to reduce the risk of stroke in people with atrial fibrillation.

As with any medical procedure, there are potential risks and complications associated with LAAC. These can include bleeding, infection, device migration, and blood clots forming on the surface of the device. It is important to discuss the potential benefits and risks of Left Atrial Appendage Closure with your electrophysiologist to determine if it is the right option for you.