Left Atrial Appendage Closure (LAAC)

LAAC in content 3Atrial fibrillation (A Fib) is a common heart rhythm disorder, or arrhythmia, that currently affects more than five million Americans. Individuals that have A Fib are at a five times greater risk of having an ischemic stroke than their counterparts with normal heart rhythms. According to StopAfib.orgOff Site Icon, one-third of patients with atrial fibrillation will experience a stroke. Why? Research shows that most A Fib related strokes have their start when blood clots form in a pocket located in the top left chamber of the heart called the left atrial appendage or LAA. Historically, the most common treatment to reduce this stroke risk has been anticoagulation therapy using blood-thinning medications such as warfarin. However, not everyone can tolerate making blood thinners a part of their daily routine.

In 2016, Premier Health was the first health care system in the Dayton area to offer certain patients living with A Fib the opportunity to reduce their stroke risks and eliminate blood-thinning medications from their daily routine. It’s a catheter-based intervention called left atrial appendage closure (LAAC) with the Watchman™ Device. This medical advancement uses a permanent implant device that can block blood flow going into the LAA during episodes of atrial fibrillation, prevent blot clot formation, avoid A Fib related stroke damage, and over-time, remove the need for daily warfarin.

Left Atrial Appendage (LAA)

Heart Cross Section graphicThe left atrial appendage is a normal part of the heart’s anatomy. Like the appendix found in the gastro-intestinal track, the LAA has no known function or purpose. It is a small, long, sac-like pocket located in the wall of the left atrium (top left chamber of the heart) that varies in size and shape. For healthy individuals with normal heart rhythms, it generally causes no problems. 

The heart has a unique electrical system imbedded within the muscle that controls the heartbeat and each relaxation/contraction cycle needed to make blood flow. The left atrium and left atrial appendage fill when the heart is relaxed, and the force of contraction empties them in the left ventricle. When blood leaves the left ventricle, it moves forward into the aorta, the body’s largest artery, and then circulates to organs and tissues. 

During atrial fibrillation, many impulses begin at the same time and spread throughout the atria. The heartbeat often becomes irregular and rapid. The chaotic electrical activity does not give the atria and LAA time to adequately fill, contract, and push blood into the ventricles. Blood flow can become turbulent during A Fib. Since the left atrial appendage is a little pocket, blood can collect inside and form clots. If these blood clots are pumped out of the heart, they may travel to the brain. Damage from blood clots can range from transient ischemic attacks or TIAs to a devastating stroke. Because of the large size of blood clots that tend to form in the LAA, A Fib related strokes can be more severe that the typical stroke, and cause higher rates of disability and death. 

Traditional Stroke Risk Reduction

Until recently, individuals with atrial fibrillation have reduced their stroke risks by taking blood thinners, like warfarin, every day. However, anti-coagulation therapy is not always well tolerated. In addition to bleeding complications, 40 percent of A Fib patients eligible for warfarin therapy are currently going untreated. Why? Because of trouble they have tolerating the medicine or are not taking it correctly. Some reasons are:

  • Unlike most medications, the dose of warfarin is adjusted according to one’s international normal ration or INR or clotting times.  
  • Frequent blood draws for INR are important. If the INR is too low, blood clots may not be prevented. If the INR is too high, there is an increased risk of bleeding. 
  • There are foods, like green leafy vegetables, that are high in vitamin K. The liver uses vitamin K to prevent excessive bleeding, so eating foods high in vitamin K can cause INR levels to fluctuate. 
  • Different medications, including antibiotics, multivitamins, and some herbal therapies, can interfere with the metabolism of warfarin. 
  • Patients on warfarin are encouraged to avoid occupations, sports, and activities that have a high risk of injury or falls, because of bleeding and bruising complications. 
  • Long-term costs and expenses never go away.

Understanding Left Atrial Appendage Closure (LAAC)

catheter insertion in contentLeft atrial appendage closure (LAAC) provides a potentially life-changing stroke risk reducing strategy that can free certain patients with atrial fibrillation from the daily challenges of taking warfarin. 

LAAC is an effective treatment option as an alternative to long-term blood-thinning medications for people who are at risk for stroke due to A Fib not associated with heart valve disease, and who are not long-term candidates for taking warfarin. This may be because of certain medical conditions, a history of bleeding while on blood-thinners, or a risk of bleeding from work-related accidents or falls. 

LAAC is a catheter-based intervention that uses a small, permanent device to seal the pocket and reduce the risk of blood clot-related complications. This therapy is performed while the heart is still beating. Why is this important? Because LAAC does not require a sternotomy, which is a large incision in the chest, or a heart-lung bypass machine, which is used to take over the functions of the heart and lungs, needed for a traditional open-chest surgery. 

To perform left atrial appendage closure, our multidisciplinary structural heart team uses a special catheter designed to carry a compressed device. While under anesthesia, the catheter is inserted into a large blood vessel, usually in the groin. Assisted by advanced imaging techniques and equipment, the catheter is gently guided through the circulatory system to the heart’s left atrium. Because left atrial appendages are shaped and sized differently in different people, our experienced team uses advanced ultrasound to take measurements, choose the appropriately sized device, and verify placement over the opening of the LAA. Once in position, the device is released, the catheter is gently removed, and the procedure is finished.

Left Atrial Appendage Closure with the WATCHMAN™ Device

Watchman IN content graphicOur structural heart specialists come from Premier hospitals located across the region. They’ve combined their advanced training and years of practice, joined forces, and created a partnership approach to offer left atrial appendage closures with the WATCHMAN™ Device at Atrium Medical Center and Miami Valley Hospital.

The WATCHMAN Device is no larger than a quarter. It has been approved in Europe since 2005, was granted US Food and Drug AdministrationOff Site Icon (FDA) approval for use in the United States in 2015, and has been implanted in more than 10,000 patients around the world. Watch an animated videoOff Site Icon of a LAAC using the WATCHMAN™ Device to learn more. 

What Else is Important for Patients to Know?

  • An advanced practice provider will guide you and your family through pre-procedure testing, post-procedure care, and recovery.
  • LAAC can be performed using monitored anesthesia care or MAC.
  • This is a one-time intervention that usually lasts about an hour.
  • Often, patients will describe their experience with left atrial appendage closure as comparable to coronary angioplasty.
  • Every person recovers differently, but because this is a catheter-based intervention many of our patients are discharged within 24 hours. Your care team will provide you with guidelines for expectations, activities, and medications.
  • After your hospital discharge, you will continue to see your family health care provider to monitor your health and atrial fibrillation.

Please remember: Not all patients being treated for atrial fibrillation with warfarin are appropriate candidates for left atrial appendage closure. We encourage you to discuss your eligibility and treatment options to reduce A Fib related stroke risk with your health care provider or one of our team members. 

Don’t Give Your Heart to Anyone. Trust Premier Health

The Structural Heart Program’s innovative technologies and techniques are designed to provide quality care for positive patient outcomes - with fewer complications, shorter recoveries, and long-lasting benefits. We welcome patients seeking second opinions on their heart disease care and treatment options. 

If you or a loved one would like more information about the many services, including the left atrial appendage closure, our Structural Heart Program offers please call (937) 499-7427(937) 499-7427.

Content Updated: January 22, 2019

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