The left atrial appendage (LAA) is a small, thin walled structure located on the front of the left atrium. The LAA has no known role in the adult heart. The LAA is the most common site (90 to 95%) for blood clot formation responsible for stroke or transient ischemic attack (TIA) in patients with atrial fibrillation.
Usual Care
For most patients in atrial fibrillation, the usual care is to be on warfarin or direct oral anticoagulant (DOAC), also known as a blood thinner, to prevent the development of clot in the LAA. Warfarin is a medication that can be difficult to manage due to the requirement of lab testing, dietary restrictions/interactions, and compliance issues. Being on a blood thinner increases the risk of bleeding, especially in the brain and abdomen.
Some patients are not candidates for warfarin or DOAC and some patients do not wish to take medications, therefore elect to have a procedure to reduce their risk of having a stroke. Most commonly, these are patients with intolerance to warfarin/DOAC, prior bleeding, or a high risk of bleeding.
Nonsurgical Intervention
Sometimes, the LAA can be closed (without surgery) by a percutaneous repair and it is done in the cardiac catheterization lab. The procedure will typically take 1-2 hours to complete and requires the use of general anesthesia, meaning you will be asleep and will not remember the procedure.
A few days before the procedure, a transesophageal echocardiogram (TEE) is performed to ensure that there is no clot in the LAA, before patients can be brought forward for a procedure. If there is a clot, the procedure is delayed until the clot is dissolved as putting catheters (a small tube) into a LAA with clot could lead to a stroke.
Procedure
A catheter (small tube) is placed into a vein in your groin and is threaded into your heart. A small poke is made in the septum between the right and left atria in order to get to the LAA. We then size the LAA, select a device, and place it into the LAA. Once the device is in the right spot, is the right size, is not moving, and there is no blood leaking around it, the device is released.
You will stay overnight in the hospital. You will go home the next day after a TTE is performed. You may have to keep taking blood thinners afterwards. This depends on the discussions with your Interventional Cardiologist.