Closure of left atrial appendage

The left atrial appendage (LAA) is a small, oval shaped sac in the muscle wall of the left atrium. 

What is a left atrial appendage (LAA)?

The left atrial appendage (LAA) is a small, oval shaped sac in the muscle wall of the left atrium. A little bit like the appendix, its unclear what the function of this is (if indeed there is one!).

Why is an LAA a problem? 

When your heart is functioning normally, the heart muscle contracts with each beat to push blood from the left atrium to the left ventricle. When a patient suffers with atrial fibrillation, the electrical impulses controlling the heart do not travel in a controlled way creating many uncoordinated impulses. These uncoordinated and uncontrolled contractions do not give the atrium time or the ability to effectively push the blood into the ventricle. This means that some blood can get left in the atrium and by default the LAA as well. This blood, as it is not moving, can form clots. When these clots are eventually pumped out of the heart they can cause a stroke.

Did you know that people suffering with atrial fibrillation are 5 - 7 times more likely to have a stroke than those with normal heart beats?

Sometimes this problem can be combatted by taking blood thinning medication such as warfarin. However, sometimes this can be troublesome for patients for reasons including:

  • Regular, frequent blood tests to check INR (international normal ratio) to test clotting time - to ensure correct dosage

  • Patients must limit intake of foods rich in vitamin k

  • Increased risk of bleeding whilst taking these medications

  • Some patients just don't tolerate warfarin well

Studies have shown that patients who experience clots but have no other heart valve problems are more likely to develop a clots which starts in the left atrial appendage. Therefore, closing of the LAA may help prevent clotting in these patients and mean that they do not need to take any blood thinning medication.

The procedure is done to close or seal off the left atrial appendage which can reduce the risk of stroke and eliminate the need for blood thinning medication.

The procedure is generally performed under general anaesthetic and the doctor is guided by x-ray and ultrasound imaging throughout the procedure. London Cardiac and Vascular Associates are the only UK unit among one of the few units worldwide who use additional imaging called echo navigator (a fusion of 3D ultrasound (echo) and angio-images) to give very accurate measurement of the appendage size and subsequent closure.

During the procedure a catheter (a long, thin, flexible tube) is inserted from a vein in the groin area and advanced to the heart via the veins. The catheter enters the heart and travels to the mouth of the appendage. The doctor, using imaging, measures the size of the appendage and places a plug-like device over the mouth of the appendage to close it.

The closure device is a parachute shaped device which expands as it closes the LAA. This prevents blood flowing into the LAA, getting stuck there and clotting.

The DAIC have a video here which show the device well.

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Healthy Living

Keeping your heart healthy involves maintaining an active lifestyle and identifying any potentially dangerous heart problems before they become more severe.