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What is left atrial appendage closure for stroke prevention?

The standard method of treatment for stroke prevention in patients with atrial fibrillation consists of oral anticoagulation therapy. A different treatment option also exists for those patients who do not tolerate this type of therapy due to bleeding complications. This consists of eliminating the source of embolisms by performing a catheter-based procedure that uses a special closure system to close the left atrial appendage (LAA occlusion device). Estimates suggest that 90% of all embolic strokes originate in the left atrial appendage.

3D echocardiogram showing clearly visible atrial appendage

The origins of left atrial appendage closure for stroke prevention

The first procedure to implant an occlusion system into the left atrial appendage was performed in 2001. Of the two currently approved occlusion systems available for this procedure, the Heart Center uses the Watchman device. This device consists of a self-expanding flexible nitinol frame structure with fixation anchors and a polyester fabric that covers the atrial-facing surface of the device.

What conditions can be treated with left atrial appendage closure?

Patients with atrial fibrillation and:

What can left atrial appendage closure achieve?

The animation shows a simplified schematic of the LAA occlusion device, which is reminiscent of a plug that is used to permanently close the left atrial appendage (LAA). A long access sheath is introduced via a vein in the groin and advanced to the right atrium. Using echocardiography and x-ray guidance technology, the inter-atrial septum is crossed and the LAA occlusion device is inserted into the left atrium.

Animation of a left atrial appendage closure procedure

Treatment steps involved in left atrial closure for stroke prevention:

Follow-up treatment

Correct positioning of the LAA occlusion device will need to be checked using transesophageal echocardiography at three and six months after the procedure.

Patients will usually require oral anticoagulation therapy for three months following the implantation, and will also need to take acetylsalicylic acid (aspirin) to inhibit platelet aggregation. After the first three months, the majority of patients will need to continue with a combination of acetylsalicylic acid (aspirin) and clopidogrel for a further 3-6 months.

Transesophageal echocardiography is used to check correct positioning of the LAA occlusion device