Left Atrial Appendage (LAA) Closure for prophylactic A-fib treatment

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In summary, Left Atrial Appendage (LAA) closure is a procedure designed to prevent stroke in patients with atrial fibrillation (A-fib) by eliminating the risk of blood clots forming in the LAA, a common site for thrombus development. This prophylactic treatment is particularly beneficial for patients who are at high risk for stroke but cannot tolerate long-term anticoagulation therapy. The procedure involves either surgical or percutaneous techniques to occlude the LAA, reducing stroke risk while maintaining a favorable safety profile and improving patients' quality of life.
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berkeman
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I just learned about this treatment option, and it seems very promising for patients (Pts) with nonvalvular atrial fibrillation (A-fib) heart dysrhythmia.

The biggest risk for Pts with A-fib is the formation of blood clots in the heart's quivering atria (the upper chambers of the heart), and those clots then traveling out into the body's bloodstream and causing blockages (especially those blockages leading to ischemic strokes in the brain). The traditional treatment (Tx) is to put the Pt on blood thinners like Coumadin or a daily baby aspirin, but this causes excessive bleeding issues that can be at least inconvenient and at most deadly.

But now it appears that there is a new class of Tx where the main part of the heart where these clots can form is actually closed or blocked off, which seems to drastically reduce the chances of blood clots forming in a heart that suffers from the A-fib dysrhythmia. I'd always assumed that the right atria was where most of the clots formed, but now I've learned that the majority form in the left atria, in a small side chamber portion called the Left Atrial Appendage. There is no known function for this side chamber of the heart, and unfortunately it mainly serves as a stagnant area of blood in the LA where clots can form in Pts with A-fib.

So there are now several ways to close or block off this LAA chamber, and that seems to drastically reduce the chances of A-fib Pts forming blood clots that can lead to ischemic stroke. Several of these Txs are mentioned in the linked article below. I've had many, many Pts over the years that I've assessed for various reasons who had A-fib (you can generally see this even without an EKG because of a particular irregular pattern in their pulse), and we usually have a conversation about talking with their doctor about their Tx options. From now on I'll be sure to mention the LAA Closure option that they should also discuss with their doc. Good stuff. :smile:

https://my.clevelandclinic.org/health/treatments/17167-left-atrial-appendage--closure


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https://www.emdocs.net/left-atrial-appendage-closure-procedure-basics-complications-and-management/
 
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Apparently it does have a function but in some types of atrial fibrillation it appears to be the source of clots, which form emboli. There appears to be a continuing debate as to whether the benefits outweigh the potential risks. In the UK it is only recommended for people who can't tolerate anticoagulants.

A couple of reviews.
https://www.ncbi.nlm.nih.gov/books/NBK553218/
https://heart.bmj.com/content/82/5/547
 
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FAQ: Left Atrial Appendage (LAA) Closure for prophylactic A-fib treatment

What is Left Atrial Appendage (LAA) Closure?

Left Atrial Appendage (LAA) Closure is a minimally invasive procedure designed to reduce the risk of stroke in patients with atrial fibrillation (A-fib) by sealing off the left atrial appendage, a small pouch in the heart where blood clots can form. This procedure can be performed using various devices and techniques, typically through catheter-based approaches.

Who is a candidate for LAA Closure?

Candidates for LAA Closure are typically patients with non-valvular atrial fibrillation who are at increased risk of stroke and have contraindications to long-term anticoagulation therapy. This includes individuals who have experienced bleeding complications from anticoagulants or those who have a high risk of falls. A thorough evaluation by a healthcare provider is necessary to determine eligibility.

What are the benefits of LAA Closure compared to anticoagulation therapy?

The primary benefit of LAA Closure is the significant reduction in stroke risk without the need for long-term anticoagulation, which can carry risks of bleeding and require regular monitoring. Patients who undergo LAA Closure may experience an improved quality of life by avoiding the complications associated with anticoagulant medications, as well as the inconvenience of daily medication regimens.

What are the risks associated with LAA Closure?

While LAA Closure is generally considered safe, it does carry some risks, including procedural complications such as bleeding, infection, and damage to surrounding structures in the heart. There is also a risk of device-related thrombus formation, which can lead to stroke. Patients should discuss these risks with their healthcare provider to make an informed decision.

How effective is LAA Closure in preventing strokes?

Studies have shown that LAA Closure can be effective in significantly reducing the risk of stroke in patients with atrial fibrillation, with some studies reporting stroke rates comparable to those achieved with long-term anticoagulation therapy. However, the effectiveness can vary based on individual patient factors, and ongoing follow-up is essential to monitor for any potential complications.

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