What is the Left Atrial Appendage?
The left atrial appendage (LAA) is a small, pouch-like structure in the upper left chamber of the heart (the left atrium). In people with atrial flutter or atrial fibrillation (AF), blood can collect in this pouch and form clots.
If a clot travels from the heart to the brain, it can cause a stroke.
What is Left Atrial Appendage Closure?
Left atrial appendage closure (LAAC) is a procedure that seals off this pouch to prevent blood clots from forming there and entering the bloodstream.
It is often recommended for people who:
- Have atrial flutter or atrial fibrillation not caused by a heart valve problem
- Are at increased risk of stroke
- Cannot take long-term blood-thinning medications (anticoagulants) — for example, due to a history of bleeding complications
How is the Procedure Done?
LAAC is performed in hospital using a minimally invasive, catheter-based technique:
- You will receive a general anaesthetic.
- A thin tube (catheter) is inserted into a vein in your groin.
- The catheter is guided up to your heart.
- A transoesophageal echocardiogram (TOE) probe is inserted into your oesophagus to provide detailed imaging of the heart structure.
- A small puncture allows access from the right upper chamber (right atrium) to the left upper chamber (left atrium).
- A small closure device is placed at the opening of the LAA.
- The device expands and seals the appendage.
- Over time, heart tissue grows over the device, permanently closing it.
The procedure usually takes 1–2 hours.
What are the Benefits?
- Reduces the risk of stroke in people with AF
- May allow reduction or cessation of long-term blood-thinning medication
- Minimally invasive — no open-heart surgery required
- Short recovery time
What are the Risks?
As with any procedure, there are some risks, although serious complications are uncommon:
- Bleeding or bruising at the catheter insertion site
- Infection
- Damage to the heart or surrounding blood vessels
- Damage to the oesophagus
- Stroke (rare, during the procedure)
- Device embolization (device coming loose)
- Pericardial tamponade (bleeding into the sac surrounding the heart)
- Device-related complications, such as incomplete sealing, movement, or clot formation on the outer surface of the device
What Happens After the Procedure?
- You will usually stay in hospital for 1–2 days
- Blood-thinning medication is typically prescribed for a short period while the device heals into place
- Follow-up imaging (echocardiogram and cardiac CT) will be arranged to confirm device position
- Most people return to normal activities within a few days to a week
Before the Procedure
You may need:
- Blood tests
- Heart imaging (echocardiogram and/or CT scan)
- Medication review — some medications may need to be temporarily stopped
Key Points
- LAAC helps prevent stroke in people with atrial flutter or atrial fibrillation
- It is an alternative for patients who cannot take long-term anticoagulants
- The procedure is minimally invasive with a relatively quick recovery