Left atrial appendage closure - for patients with AF who cannot tolerate anticoagulation from bleeding or allergic reaction.

Procedures - Left Atrial Appendage Occlusion

 

Left Atrial Appendage Occlusion

The left atrial appendage is a vestige of embryological development.

 

This small structure has some hormonal functions but its functions are other wise unknown. It is a structure of very variable size and shape. However, in patients who develop atrial fibrillation which is an irregular heart beat it is possible for blood clots to lodge in this structure. In patients with atrial fibrillation 80% of the strokes occur due to blood clot forming in the left atrial appendage and being sent of to the brain with the blood flow. Most patients can be treated with anti-coagulation such as Warfarin (Aspirin is not always sufficiently powerful for this purpose) to prevent this blood clot formation.

 

However many patients can either not tolerate Warfarin or are unable to take it for other reasons. In these patients they remain at significant risk of stroke. We have a device available called an Amplatzer Plug which sits in the appendage blocking its opening and prevents the clot forming.

 

 

3D echo view showing the mouth of the left atrial appendage.

 

Amplatzer plug

 

Amplatzer plug

This reduces the risk of stroke to that which would occur if you were taking Warfarin. These plugs are placed by passing them through the veins in the right atrium by transeptal puncture with a long needle through to the left atrium and then into the appendage.

 

Although this is a new procedure the evidence for its benefit is growing and I envisage that it will become very popular in the future as patients are unable or decline to take Warfarin in the long term with all its attendant risks.

 

     

Figures showing contrast on Xray in the left atrial appendage, then delivery of the device and its detachment. Finally an injection showing the appendage completely sealed off.

 

Who needs left atrial appendage closure?

Patients with atrial fibrillation who cannot tolerate anticoagulation either from bleeding or allergic reaction

 

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