Left Atrial Appendage Closure (LAA)

Left Atrial Appendage (LAA) closure is a medical procedure used to treat atrial fibrillation (AFib), a type of heart rhythm disorder. The left atrial appendage is a small pouch-like structure in the heart that can trap blood clots, which can then lead to a stroke if they break free and travel to the brain.

In LAA closure, a device is implanted into the left atrial appendage to block blood flow and prevent blood clots from forming. This is typically done via a catheter-based procedure, in which a device is inserted through a vein in the leg and guided to the heart. The device is then deployed inside the left atrial appendage and anchored in place, effectively sealing it off.

LAA closure is often used as an alternative to long-term anticoagulation therapy, which is the standard treatment for preventing stroke in patients with AFib. LAA closure can be especially beneficial for patients who are at high risk of bleeding or cannot take anticoagulants for other reasons.

What are the Types of left atrial appendage closure devices?

There are several types of left atrial appendage closure devices, including:

1. Watchman: a device made of nitinol (a shape memory alloy) that is delivered via a catheter and permanently implanted in the LAA to block blood flow.
2. Amplatzer Cardiac Plug: a device made of wire mesh that is delivered via the catheter and permanently implanted in the LAA to block blood flow.
3. Lariat: a device that uses a suture to ligate the LAA, effectively closing it off.
4. AnchorRite: a device that uses a mesh-like scaffold and a suture to occlude the LAA.
5. AtriClip: a device that uses a metal clip to occlude the LAA.

These devices are used to reduce the risk of stroke in patients with atrial fibrillation.

WATCHMAN™ Device 

The WATCHMAN™ Device is a type of catheter-inserted closure device used for the treatment of non-valvular atrial fibrillation (AF). It is designed to reduce the risk of stroke in AF patients who are unable or unwilling to take long-term anticoagulation therapy.

The WATCHMAN™ device is delivered via a catheter, which is guided to the left atrial appendage (LAA) of the heart. Once in place, the device is deployed and expanded, blocking blood flow into the LAA and reducing the risk of blood clots forming. The device is made of nitinol (a shape memory alloy) and is designed to be a permanent implant.

The procedure to implant the WATCHMAN™ device is typically performed under conscious sedation and takes about an hour to complete. The device has been shown to be effective in reducing the risk of stroke and is an alternative to long-term anticoagulation therapy. 

However, it is important to note that the procedure is not suitable for all patients with AF and the decision to undergo the procedure should be made in consultation with a physician.

Who needs to have left atrial appendage closure?

Left atrial appendage closure (LAAC) is typically recommended for individuals with non-valvular atrial fibrillation (AF) who are at high risk of stroke and are unable or unwilling to take long-term anticoagulation therapy.

This procedure may be recommended for people with AF who have:

1. Contraindications to taking anticoagulant medications such as warfarin or dabigatran.
2. A high risk of bleeding due to other medical conditions or medications.
3. Difficulty in managing their anticoagulation therapy, such as poor INR control.
4. An increased risk of stroke based on CHA2DS2-VASc score.

It is important to note that LAAC is not recommended for all patients with AF and the decision to undergo this procedure should be made in consultation with a physician, who will consider the individual's medical history, overall health, and other factors.

What are the risks involved in the Left Atrial Appendage Closure (LAA) procedure?

Left Atrial Appendage Closure (LAA) is a minimally invasive procedure, but like any medical procedure, it carries some risks. Some of the potential risks associated with LAA closure include:

1. Procedure-related complications: These may include bleeding, infection, damage to blood vessels or adjacent structures, or perforation of the heart or blood vessels.
2. Device-related complications: These may include device embolization (movement of the device from its original position), device thrombosis (formation of a blood clot on the device), device erosion into adjacent structures, or device malfunction.
3. Stroke: Although the procedure is intended to reduce the risk of stroke, there is a small risk of a stroke occurring during or after the procedure.
4. Recurrent Atrial Fibrillation: There is a small risk that the patient may develop recurrent atrial fibrillation after the procedure.
5. Persistence or recurrence of blood clots: In rare cases, blood clots may persist or recur despite the closure of the LAA.

It is important to discuss the risks and benefits of LAA closure with a physician and to carefully consider the individual's medical history, overall health, and other factors before deciding to undergo the procedure.

Closing Thought 

Dr Amit Bhushan Sharma is a great cardiologist who combines excellent medical knowledge with compassionate patient care. He was awarded the best-cardiologist award in 2022 by Indian Medical Association. He has a deep understanding of the latest advancements in cardiology and is able to apply this knowledge to diagnose and treat patients effectively. He is skilled in a variety of diagnostic techniques and procedures, including TAVR, TAVI, nuclear stress tests, and electrophysiology studies, and is able to use these tools to make accurate diagnoses. 

By combining expertise with empathy, he provides their patients with the highest quality of care and helps them manage their heart health for a lifetime. In 2007, the well-known KEM Hospital in Mumbai gave Dr. Amit Bhushan Sharma a gold medal for his work on his DM in cardiology.