Atrial Fibrillation and Stroke Risk
Atrial fibrillation is a type of irregular, and sometimes rapid heart rhythm arising from the upper chambers (called the atria) of the heart. Atrial fibrillation can cause blood to pool in a part of the left atrium, called the left atrial appendage (LAA), and form clots. These clots can travel to the brain and cause a stroke. Blood-thinning medications are a first-line treatment to minimize the risk of stroke. Some commonly used medications include Xarelto, Eliquis, Pradaxa, and warfarin. While effective at reducing the risk of stroke, blood thinners also increase the risk of bleeding complications. For some patients, the side effects and lifestyle changes that accompany lifelong blood thinners are intolerable.
Left Atrial Appendage Occlusion(LAAO)
Left atrial appendage occlusion (LAAO) devices offer an alternative to lifelong anticoagulation. LAAO is a minimally invasive procedure performed in the cardiac catheterization lab. A small puncture is made in the femoral vein in the leg. The closure device, such as the Watchman TM , is guided up to the heart with a small catheter, and is positioned in the left atrial appendage. This device is then deployed, sealing the opening of the appendage, creating a barrier against blood clots that cause a stroke.
After six months, a layer of cells forms over the top of the device fully occluding the appendage. At that point, most patients only need to be on a baby aspirin.
What to Expect
On the morning of your procedure, you will check in at the hospital. After thorough preparation, the procedure will be performed in the Cardiac Catheterization laboratory. Your vital signs will be monitored closely during the procedure and until discharge. Most patients undergoing LAAO stay one night or less in the hospital. It is important to continue taking your blood thinning medications for the first 6 months.
After leaving the hospital, you will have a follow up appointment with your Cardiologist in about 1 week. Six weeks following your procedure, a repeat transesophageal echocardiogram is performed to reassess the device positioning. At that point, the blood thinners begin to be de-escalated.
A Multidisciplinary Team Approach
A multidisciplinary team approach is critical for achieving optimal patient outcomes. Patients undergoing LAAO are under the care of a highly experienced multidisciplinary heart team consisting of an Interventional Cardiologist, Anesthesiologist, Nurse, and Imaging Specialist.
Linda Sprague, MSN, RN
Structural Heart Nurse Navigator
Physicians and Specialists
Aaron Yung, MD, FACC
David Cohen, MD
Mohammad Pashmforoush, MD