Left Atrial Appendage Closure (Occlusion)

Older patients with an abnormal cardiac rhythm known as atrial fibrillation are at increased risk of stroke due to clot formation within the heart, which may break off and travel to the brain, blocking a blood vessel there. About 90% of such clot forms in a sort of pouch arising from the left atrium, known as the left atrial appendage.

The mainstay of treatment is to prevent clot formation with the use of anticoagulant drugs (blood thinners), such as warfarin, or the newer agents such as dabigatran (Pradaxa) or rivaroxaban (Xarelto). These agents are highly effective and reduce the risk of stroke very substantially, but by the nature of their action they increase the risk of bleeding. Some people cannot take them for this reason, and are therefore unprotected from the risk of stroke associated with atrial fibrillation (stroke can be caused by many other things too!).

In such patients the implantation of a device into the mouth of the left atrial appendage through a tube introduced from a vein in the leg, effectively blocking the appendage off, has been shown to be as effective as anticoagulants at reducing the stroke risk without increasing the bleeding risk. The procedure is done using transoesophageal echo to visualise the device during implantation, which for most patients requires a general anaesthetic for comfort. Most patients stay in hospital for one night only.