Left Atrial Appendage Occlusion Procedure

The current approach for atrial fibrillation patients who are at increased risk for stroke is treatment with blood-thinning medications called anticoagulants, which reduce the chance that blood clots form in the heart. These medications, which include warfarin, commonly referred to as Coumadin and other newer approved anticoagulants, are effective in lowering the risk of stroke in atrial fibrillation patients. Most patients can safely take these medications for years (and even decades) without serious side effects. However, some patients find that anticoagulants can be difficult to tolerate or risky. Because they prevent blood clots by thinning the blood, anticoagulants can increase the risk of bleeding problems. When bleeding events occur, the events are often minor (like a skin cut taking longer to stop bleeding than normal) and easily treated. But in some cases, bleeding can be quite serious requiring hospitalization and transfusion and can even be life-threatening or fatal (such as when strokes are caused by bleeding into the brain).

When prescribing anticoagulant medications in atrial fibrillation patients, doctors consider the risk of a stroke caused by a clot versus the risk of a serious bleeding problem. In studies of atrial fibrillation patients, the benefit of a reduced risk of stroke caused by a blood clot traveling from the left atrial appendage is greater than the risk of major bleeding (including strokes caused by bleeding into the brain). This means that more strokes are prevented by anticoagulant medications than are caused by anticoagulant medications. Therefore, anticoagulant medications are recommended for most patients. However, in select patients, the risk of major bleeding is believed to be too high, that anticoagulants will not be prescribed. Other atrial fibrillation patients, even though they may be able to take anticoagulant medications without major bleeding, may choose not to take the medication because of minor bleeding episodes, other medication side effects, or concerns about bleeding due to falls
or trauma.

When a blood clot develops in the heart of a patient with atrial fibrillation, it is most often found within the left atrial appendage. Occlusion of the left atrial appendage using a catheter-delivered device implant (WATCHMAN) acts as a barrier to prevent left atrial appendage blood clots from entering the bloodstream and blocking a blood vessel in the brain resulting in a stroke. This has been shown to be non-inferior to taking the blood thinner “Warfarin”. The WATCHMAN Implant is placed into the heart using a minimally invasive procedure in the electrophysiology laboratory. In preparation for the implant, you will be lying on your back on a table while you are continuously monitored throughout the procedure by medical personnel. X-rays and echocardiograms (a special type of ultrasound picture) will be used to help visualize the heart while the implant is being advanced into the correct position in your heart. Contrast media (dye) will also be injected to help guide the implant placement. You will be given a general and/or local anesthetic by your doctor to minimize any discomfort during the procedure.

A small puncture is made into a vein in your groin. A long, thin tube, called a catheter, is inserted into the vein and advanced into the right atrium of the heart. Another puncture is made through a thin muscle wall between the right atrium and the left atrium so that the catheter can be advanced into the left atrium. A thinner catheter is then advanced into the left atrial appendage under X-ray guidance. The WATCHMAN Implant is tightly compressed within the catheter and is passed through the catheter into the left atrial appendage. The physician will make sure that the implant is in the right place within the left atrial appendage and then deploy the implant (much like opening up a folded umbrella). After the procedure, the WATCHMAN Implant is the only material that remains in the body. A thin layer of tissue will grow over the surface of the WATCHMAN Implant within about 45 days.

It is important to remember that the left atrial appendage closure procedure does not cure AFib. If you undergo this procedure, you will still need to work with our physician to manage the symptoms of AFib if you have any. This procedure also does not totally eliminate the possibility of blood clots, they eliminate the possibility of blood collecting in the left atrial appendage , which is where most Afib-related blood clots form. Nevertheless, blood clots can still form elsewhere in the body and cause stroke or other problems.