The left atrial appendage (LAA) is a small pouch extending off the side of your left atrium in the heart that can act as a decompression chamber when atrial pressure is high.
While everyone has an LAA, the size and anatomy varies, as do the issues it can cause. The LAA sits off the to side of the pulmonary arteries that bring in blood from the lungs, and its position can cause blood to pool there instead of flowing into the left ventricle of your heart.
Atrial fibrillation (AFib) patients experience poor atrial contractions during an episode. Those weak contractions, combined with blood pooling, resulting in clot formation — most of which form in the LAA. Blood thinners can help reduce the risk of clots and the strokes they cause. If you are unable to safely take long-term blood thinners, your best option to prevent clot formation may be to close off the LAA so that the blood cannot pool there.
If you have another condition that increases your risk of stroke, your doctor might recommend an LAA closure procedure — even if you don't have AFib.
Procedures for Left Atrial Appendage Closure
By closing off the LAA, blood cannot pool in the area and clots cannot get into your left atrium and your circulatory system. We offer two methods of LAA closure — the WATCHMAN™ device and the AtriClip®. Both devices accomplish the same result, so we look at your overall health to determine which is the best option for you.
WATCHMAN Device — What Is It and Who Is a Candidate
A WATCHMAN device is a plug that is inserted through the blood vessels into the heart and positioned within the LAA to block the appendage and prevent blood from entering and pooling. It is an option if you should be on blood thinners, but cannot safely tolerate long-term anticoagulation medication, such as Warfarin.
The device should be considered for nonvalvular atrial fibrillation patients who have:
- A history or prior experience of bleeding while taking oral anticoagulants
- A career or lifestyle that increases the risk of bleeding
- An inability to maintain stable international normalized ratio (INR), comply with regular INR monitoring or are unable to take direct oral anticoagulants (DOACs)
Under general anesthesia, we perform a transesophageal echocardiogram to verify there is no clot in the LAA and then use this imaging to guide the device placement. We use a minimally invasive approach through a vein in the leg to insert the WATCHMAN device (similar to a coronary stent procedure).
After approaching the heart through the vein, the surgeon makes a small puncture in the muscle-bridge separating the atria in order to advance the device to left atrium. Using the echo imaging guidance, the surgeon deploys the device in the atrial appendage. After verifying successful placement, we leave the device in place, remove the catheter from the body and close the incision. The entire procedure takes about an hour.
WATCHMAN Device and Procedure Risks
In rare cases, there may be bleeding, clot formation, stroke or bleeding around the heart. Also rare, are instances where the device does not successfully deploy or dislodges from the LAA opening. It should be noted that these are not regular occurrences, and the use and placement of the device is very safe.
We performed our first WATCHMAN device implantation in 2016 and implanted more than 150 of these devices.
After the Procedure
You will be up and moving 6 hours after the procedure and stay one night in the hospital for observation. You'll go home the next day with lifting and exercise restrictions for 3 to 5 days.
AtriClip — How It Works
The AtriClip is like a clothespin placed externally over the LAA opening to pinch the entrance to the LAA closed from the outside of the heart. A cardiothoracic surgeon can place the device using small incisions in the chest wall.
It is a good option for patients are not able to have the WATCHMAN device implanted via a catheter threaded up from the leg and into the heart. It also has a lower stroke risk for patients with AFib. AtriClip implantation can be done at the same time as some other cardiac procedures, so it's a good choice to reduce the number of surgeries.
What to Expect When Placing the Device
You will be put under general anesthesia. The surgeon will make four dime-sized incisions in your left side and inserts a camera scope and robotic instruments. After identifying the LAA, the surgeon places the clip at the base of the LAA to block blood from entering.
The procedure takes about an hour, though your surgery may last longer if you are having additional procedures done at the same time. You will need to stay one or two nights in the hospital.
Recovery After Placement
Your incisions will be sore for 2 to 3 weeks. You can resume normal activity, but strenuous activity will likely cause additional discomfort. While you won't have any lifting or exercise restrictions from the AtriClip placement, there may be restrictions based on other procedures you had. Ask your care team to be sure.
Expertise and Experience in Closing the LAA
Our team includes experienced electrophysiologists, interventional cardiologists and cardiothoracic surgeons working together to determine the best approach for your individual case. We are a high-volume center — performing more of these procedures means we have more experience. Since our multidisciplinary team can offer both the WATCHMAN and AtriCip devices, you have options to meet your individual needs regardless of anatomy.
Research and Clinical Trials
In addition to providing the latest treatment options for LAA management, our providers are also involved in clinical research to uncover additional options for AFib patients. One such trial, is the Catalyst trial using Abbott’s Amulet device for LAA closure.