This is performed in patients with atrial fibrillation who have a high risk of stroke and cannot take anticoagulation
Left atrial appendage closure – for patients with AF (Atrial Fibrillation) who cannot tolerate anticoagulation from bleeding or the left atrial appendage is a vestige of embryological development.
This small structure may have some hormonal functions, but mostly its functions are otherwise 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 off to the brain with the blood flow. Most patients can be treated with anti-coagulation such as Warfarin or the newer anticoagulants (apixaban,rivaroxaban). Aspirin is not sufficiently powerful enough for this purpose, which is to prevent blood clot formation.
However some patients can either not tolerate anticoagulants or are unable to take it for other reasons such as severe internal bleeding. In these patients they remain at significant risk of stroke. We have a device available called an Amplatzer Plug (amulet) or watchman device which sits in the appendage blocking its opening and prevents the clot from forming in the first place.
This reduces the risk of stroke to that, which would occur, if you were taking anticoagulation. These plugs are placed by passing them through the veins in the right atrium by via a procedure called a Transeptal Puncture. A Transeptal Puncture is the process of passing a long tube through the thin membrane between the right and left atrium with the aid of a long needle.
The evidence for the benefits of this procedure is growing and it is envisage that it will become very popular in the future, as patients are unable to or decline to take anticoagulation in the long term with all its attendant risks. Risks of anticoagulation drugs include internal bleeding from just about anywhere such as the gut, the mouth and especially the brain.
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