What Is a Left Atrial Appendage Closure?
A left atrial appendage closure is a procedure your doctor may recommend if:
- you have atrial fibrillation (also known as AF or AFib) or
- you are not a good candidate for taking blood thinner medication long-term.
This procedure will reduce your risk for future strokes much like take blood thinners would. You may not even need to take blood thinners after undergoing a left atrial appendage closure.
AFib and Your Left Atrial Appendage
Your left atrial appendage (LAA) is a small pouch on your heart’s left atrium, where blood normally flows in and out. AFib is an irregular heartbeat that is caused by irregular electrical signals in your heart, which can lead to blood clots in your LAA. Blood clots can travel through your blood stream and cause a stroke. Blood thinners are typically our first course of treatment to prevent blood clots from forming. However, if long-term use of blood thinning medication is not a viable option for your health, we will close your LAA with surgery.
Left Atrial Appendage Closure Procedures
Our doctors use two of the most common approaches to close your heart’s left atrial appendage — the Watchman device and AtriClip. We will discuss all of your options to find the best treatment for you and your health.
The Watchman device is an implant that we use to close your left atrial appendage (LAA). We insert this device using a catheter (a thin, flexible tube) instead of performing open heart surgery.
We will put you to sleep using general anesthesia. Once you are asleep, we will place a delivery catheter (a thin, flexible tube) in a vein near your groin and guide it to the upper right chamber of your heart. Then, we will make a small hole between your heart’s two upper chambers so the catheter can reach the left atrium.
The Watchman device will be pushed through the catheter into your left atrial appendage where it will self-expand into a parachute shape with a cap. After the procedure, your heart tissue will gradually grow over the device to seal your LAA and prevent the release of blood clots.
The AtriClip is a device that closes around the outside of your left atrial appendage to prevent blood flow there. We will need to perform open-heart surgery to insert the AtriClip. If you are a viable candidate, we may use robotic instruments to perform this procedure, which can be beneficial in many ways such as less pain, quicker recovery time, and a shorter hospital stay.
We will put you to sleep under general anesthesia much like we do for the Watchman procedure. We will make a small, one-centimeter incision (cut) on the left side of your chest and use a camera and port (a pouch attached to a catheter to reduce the wear and tear on your veins) to access the left atrial appendage. We will position the AtriClip around the outside of your heart’s left atrial appendage and then close it to shut off blood flow to the area. Your incision will be sewn shut with stitches, which we will remove at a later date.
We will use a transesophageal echocardiogram (TEE) to ensure that your left atrial appendage is completely closed. This imaging test uses an endoscope (a long, thin tube) to guide the ultrasound transducer down your throat to see images of the heart without your ribs or lungs getting in the way. After your surgery is complete, we will insert a chest tube to drain any excess fluid. You will be discharged from the hospital as early as the next day.
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Left Atrial Appendage Recovery Time
The recovery process for left atrial appendage closures differs from patient to patient and depends on the type of procedure you have. Most patients generally recover quicker from the Watchman procedure since the AtriClip insertion requires open-heart surgery. Your doctor will discuss recovery and surgery aftercare in detail with you.
Watchman Procedure Recovery
- After this procedure, you will stay overnight in the hospital. If you are recovering well, we will send you home and schedule you for a follow-up appointment.
- With your doctor’s approval, you should be able to resume most normal activities within a week.
- We will perform a transesophageal echocardiogram (TEE) on you within 45 days after the procedure. This imaging is used to evaluate any blood flow leaks around the device as well as possible blood clots. If none of these exist, we will take you off of any blood thinning medication.
- A regular echocardiogram (a heart ultrasound) will be performed 60 days after surgery.
- Once we see that your LAA has completely closed, we will start scheduling you for follow-up appointments once a year.
AtriClip Device Recovery
- You will stay in the hospital for about 24 to 48 hours after surgery.
- Your doctor and nurses will give you specific instructions on incision (cut) care, medications, and other recommendations.
- Within two weeks of surgery, you will have a follow-up appointment to remove your stitches. We may also schedule you to start cardiac rehabilitation to support your recovery, if needed.
- You should be able to resume most of your normal activities about a week after surgery.
You will need a referral from a primary care physician, cardiologist, or other healthcare provider to schedule your initial consultation with one of our specialists for a left atrial appendage closure. Please call our structural heart team at 801-213-5922 to set up your first appointment.