Left Atrial Appendage Closure
Left atrial appendage (LAA) closure is a preventive procedure designed to reduce the risk of stroke in patients with certain heart conditions, particularly atrial fibrillation (AF). The left atrial appendage is a small, pouch-like structure in the upper left chamber of the heart that has no essential function.
In people with atrial fibrillation, where the heart beats irregularly and inefficiently, blood may pool in the LAA. This can lead to clot formation, increasing the risk of those clots travelling to the brain and causing a stroke. LAA closure seals off this pouch to prevent blood from collecting there, often eliminating the need for long-term blood-thinning medications.
What does it do?
LAA closure reduces the risk of stroke associated with non-valvular atrial fibrillation by preventing blood from pooling and clotting in the appendage. When the heart doesn’t pump efficiently—particularly in AF—not all blood is ejected from the atrium during each heartbeat. The LAA is a common site for this blood to stagnate and form clots.
By sealing off the LAA, this procedure:
- Minimises the risk of clot-related stroke
- Offers an alternative to long-term anticoagulants (e.g., warfarin)
- Provides peace of mind for patients who cannot tolerate or prefer to avoid blood thinners
After the procedure, patients are monitored in the ward, and a transoesophageal echocardiogram (TOE) may be repeated to confirm the position of the closure device before discharge. You will be given clear instructions on recovery and wound care at home.
How does it work?
In a normal heartbeat, blood is pushed from the left atrium into the left ventricle. In atrial fibrillation, the electrical signals controlling the heartbeat become erratic, resulting in ineffective pumping. This leads to incomplete emptying of the atrium, allowing blood to pool in the LAA—an ideal location for clot formation.
LAA closure works by sealing off the opening of this pouch using a special closure device. This does not interfere with the heart’s overall function, but it significantly reduces the chance of blood clots forming in this high-risk area.
Why is it performed?
Your doctor may recommend LAA closure if:
- You have non-valvular atrial fibrillation
- You are at increased risk of stroke
- You are unable to take blood-thinning medications due to side effects, bleeding risks, or other medical concerns
For these patients, LAA closure can be an effective alternative to lifelong anticoagulation therapy.
The procedure
LAA closure is usually a minimally invasive, catheter-based procedure, though it can be performed surgically in select cases.
Steps include:
- A TOE scan may be done before the procedure to ensure no clots are present.
- Local or general anaesthetic is administered.
- A catheter is inserted through a vein in the groin and guided to the heart.
- Using X-ray imaging and ultrasound guidance, a closure device is delivered to the opening of the left atrial appendage.
The device is expanded to seal the entrance, and over time, heart tissue grows over the device, securing it permanently in place.
Recovery
After the procedure:
- You’ll be monitored in the hospital for a short period.
- A follow-up TOE scan may be performed before discharge to confirm the device is well positioned.
- Your medical team will provide you with comprehensive discharge instructions, including wound care, medications, and activity guidelines.
Most patients recover quickly and are able to return to normal activities within a few days, depending on individual circumstances.