Left Atrial Appendage Closure (LAAC)

Left Atrial Appendage Closure (LAAC) is a type of minimally invasive procedure (small incisions of 2–3 inches long / general anesthesia), performed to seal the left atrial appendage (LAA). This is done to reduce the risk of blood clot related complications. The left atrial appendage, a normal part of the heart’s anatomy, plays an important role in the initial development of the heart but serves no significant function after we are born. It is a sac-like pocket located in the wall of the left atrium (heart’s top chamber). For healthy individuals with normal heart rhythms, it generally causes no problems. However, for individuals with abnormal rhythms (e.g. atrial fibrillation), there are potential medical risks.

During atrial fibrillation (AFib), the heartbeat is erratic. This chaotic electrical activity does not give the atria and LAA time to rhythmically fill, contract, and push blood into the ventricles (heart’s lower chambers). The blood flow can become stagnant during A-Fib and potentially lead toward blood collecting inside the LAA. This can lead to the formation of blood clots. If these blood clots are pumped out of the heart, they may travel to the brain and cause a transient ischemic attack or a stroke or embolism.

The devices used to close off the LAA are permanent and do not need to be replaced. Their primary function is to prevent blood clots from developing and escaping; thus, reducing the risk of stroke, eliminating the need for regular blood tests and removing any food or drink restrictions (usually necessary when taking blood-thinners).

However, in some cases, your medical team may recommend that your left atrial appendage be removed surgically, if you are already planning to undergo a cardiac surgery. Your doctor will discuss your options.

How to prepare for the procedure

Prior to the procedure, your doctor and treatment team will explain to you what to expect before, during and after the procedure and potential risks of the procedure. Other recommendations include:

Talk to your doctor about

  • All medications, herbal products and dietary supplements you are currently taking and ask for their recommendations about each
  • Diabetes and how to adjust your medicine on the day of the procedure
  • Any allergies to medicines, latex, tape, iodine, and anesthetic agents
  • Any history of bleeding disorders
  • Any implanted device (e.g. pacemaker or ICD)

Other suggestions

  • Eat a normal meal the evening before the procedure. However, do not eat, drink or chew anything after midnight before your procedure. If you must take medications, only take them with sips of water.
  • Leave all jewelry at home
  • Remove all makeup and nail polish
  • Wear comfortable clothing when you come to the hospital.
  • If you normally wear dentures, glasses, or hearing devices at home, plan to wear them during the procedure.

What to expect before the procedure

Prior to undergoing placement of an LAAC device or not, your doctor might perform a variety of tests, including:

Diagnostic tests and procedures

What to expect during the procedure

An LAAC procedure usually takes 1 hour, but the preparation and recovery time may add several hours. LAAC is usually performed in the cardiac catheterization lab. Check with your doctor about the details of your procedure. In general:

  • You will change into a hospital gown.
  • A nurse will start the intravenous (IV) line in your hand or arm allowing medications and fluids to be administered during the procedure.
  • An anesthesiologist will provide anesthesia so that you are comfortably asleep for the procedure. Your physician will use a local anesthetic to numb the insertion site. The insertion site is usually a blood vessel (artery) in your groin.
  • Once the local anesthetic has taken effect, a small needle is used to access the vein.
  • A vascular catheter (delivery tube) is inserted.
  • Through the delivery catheter in your vein, the LAAC device is inserted and guided into the LAA of your heart.
  • After you are asleep, an ultrasound catheter is placed in your esophagus to help your doctor visualize placement of the device.
  • Once in place, the LAAC device is deployed and the LAA is completely closed off.
  • Once the procedure is complete, the catheter is removed and the insertion site is closed with the use of an absorbable suture .

What to expect after the procedure

You'll be monitored overnight in a hospital room. Most patients go home the following day. Other recommendations include:

General guidelines

  • A nurse will monitor your vital signs, the insertion site, and circulation and sensation in the affected leg.
  • You must stay in bed for several hours as recommended by your doctor.
  • Tell your nurse right away if you feel any chest pain or tightness, or any other pain, as well as any feelings of warmth, bleeding, or pain at the insertion site.
  • When you are discharged, your doctor will give you instructions to follow during your recovery.

Clinical trials

AMULET

Saint Barnabas Medical Center
94 Old Short Hills Road
Livingston, NJ 07039
(973) 322-5000
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Newark Beth Israel Medical Center
201 Lyons Avenue at Osborne Terrace
Newark, NJ 07112
(973) 926-7000
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Robert Wood Johnson University Hospital
1 Robert Wood Johnson Place
New Brunswick, NJ 08901
(732) 828-3000
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Left Atrial Appendage Closure Treatment & Care

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