Left Atrial Appendage Closure
The prevention of strokes in patients with AF relies heavily on blood thinners, but many patients encounter issues with this type of medication and require an alternative solution. In the past, patients had to choose between taking blood thinners and risking bleeding, or not taking them and risking a devastating stroke. Fortunately, left atrial appendage closure now offers an exciting alternative to this difficult decision.
What is it?
In atrial fibrillation, blood can pool and form clots in a part of the heart called the left atrial appendage. These clots can break loose and cause a stroke. However, left atrial appendage closure is a minimally invasive procedure that offers a solution to this problem. By inserting a specially designed device into the appendage, it can be closed off from the rest of the circulation, preventing the formation of clots in that area. This can greatly reduce the risk of stroke in patients with atrial fibrillation who cannot tolerate blood thinners.
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This procedure has changed my life
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Dr Hsieh discusses left atrial appendage closure and how it can help both the risk of stroke, and reduce bleeding.
Left atrial appendage closure procedure
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When preparing for the implantation of the device, you should follow the typical guidelines for elective medical procedures. You must abstain from eating or drinking anything after midnight the night before the procedure unless directed otherwise. It is essential to pack for an overnight stay in the hospital, including all your regular medications. Please arrange transportation to and from the hospital, as you will not be allowed to drive until the sedatives have worn off. Since the length of time it takes for the sedatives to wear off can vary, it is recommended that patients avoid driving for 24 hours following the procedure to ensure their safety.
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On the day of the procedure, the setup may take some time, but our nursing staff will be there to support you throughout. You will be given anaesthesia to ensure your comfort during the procedure, and a local anaesthetic will be applied to your groin before a small incision is made for the catheter insertion. The catheters will be gently guided through your veins and up to the right side of your heart using specialised x-rays known as "fluoroscopy." A specialised needle will then be used to create a small hole from the right to the left side of your heart, allowing the device to be deployed in the left atrium.
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After the procedure, the catheters will be taken out, and pressure will be applied to the insertion site to minimize any bleeding. Dr. Hsieh may apply a regional nerve block and special sutures on the blood vessel itself to minimise bleeding and the duration you need to lie still. You will need to stay in bed for at least 3-4 hours, and in the hospital overnight for observation. Once you are allowed to move around, you may feel some stiffness as a result of lying still for a long time. There may be some discomfort in your throat, groin, or chest from the procedure.
Your blood thinners may be continued for a short period, or there may be a switch to a different medication during this time. Over the long term, only aspirin will be necessary. -
After the procedure, Dr. Hsieh will remove the catheters and apply pressure to the insertion site to minimise any bleeding. To further reduce bleeding and the duration of having to lie still, a regional nerve block and special sutures on the blood vessel may be applied. Expect to remain in bed for at least 3-4 hours and spend the night in the hospital for observation. Following this, you may experience some stiffness from being immobile for an extended period and some discomfort in the throat, groin, or chest.
Depending on your situation, you may need to continue taking blood thinners for a short period or switch to a different medication. However, in the long run, aspirin will be sufficient.