Left Atrial Appendage Closure Device

The Left Atrial Appendage (LAA) is a small, ear-shaped pouch located on the upper left chamber of the heart (left atrium). For individuals with atrial fibrillation (AFib) not caused by a heart valve problem, the LAA is where more than 90% of stroke-causing blood clots form.

A Left Atrial Appendage Closure (LAAC) device is a medical implant designed to seal off the LAA, preventing blood clots that form within it from entering the bloodstream and potentially causing a stroke. It offers an alternative for patients with non-valvular AFib who are at high risk for stroke but cannot take long-term oral anticoagulants (blood thinners).

 

The device works by physically closing or sealing the LAA. This creates a barrier, effectively isolating the appendage from the rest of the left atrium. Any blood clots that might form within the LAA are then contained within it, unable to travel to other parts of the body, such as the brain. Over time, heart tissue grows over the implanted device, permanently sealing off the LAA.

LAAC devices are primarily indicated for patients with:

  • Non-valvular Atrial Fibrillation (AFib):This means AFib not caused by a heart valve disease caused by Rheumatic Heart Disease.
  • High Risk of Stroke:Determined by a CHADS2-VASc score indicating a significant risk.
  • Contraindications to Long-Term Oral Anticoagulation (OAC):This is the key indication. Patients who have a history of serious bleeding while on blood thinners, or who have conditions that make blood thinners unsafe (e.g., recurrent falls, certain occupations), are the only candidates at this time.

The implantation of an LAAC device is typically a minimally invasive procedure performed in a cardiac catheterization lab.

  1. Access: The procedure usually begins with a small incision in the groin area to access the femoral vein. A catheter (a thin, flexible tube) is then guided through the vein, up to the heart.
  2. Transseptal Puncture: To reach the left atrium (where the LAA is located), the cardiologist performs a transseptal puncture. This involves carefully creating a small opening in the wall (septum) between the right and left atria.
  3. LAA Visualization and Measurement: Once in the left atrium, imaging techniques like transesophageal echocardiography (TEE) are used to precisely visualize and measure the LAA’s size and shape.
  4. Device Delivery: The LAAC device, compressed within a delivery catheter, is advanced through the transseptal puncture and carefully deployed into the opening of the LAA. The device is designed to conform to the LAA’s anatomy, sealing it off.
  5. Confirmation and Release: Once the device is in the correct position and fully expanded, its stability and proper sealing are confirmed using imaging. If satisfactory, the device is released from the delivery catheter.
  6. Closure: The catheters are then carefully withdrawn, and the access site in the groin is closed.

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Several LAAC devices are available, each with unique designs, but all aim to achieve the same goal: sealing off the LAA.

  • WATCHMAN Device (Boston Scientific):This is one of the most widely used and studied LAAC devices. It’s a parachute-shaped device made of a nitinol frame with a permeable fabric cap. It’s designed to be implanted at the opening of the LAA.
  • Amulet Device (Abbott):The Amulet device features a dual-seal design with a lobe and a disc, which allows it to conform to a wide range of LAA anatomies. It’s made of a nitinol mesh framework with ePTFE patches.