Left Atrial Appendage Closure
The left atrial appendage or LAA is a small outpouching of heart tissue from the left atrium. Very much like the appendix, we don’t have a full understanding of why it is useful to the heart, but we do know that it is not critical to the heart’s function. However, while it has no discernible use, it does represent a significant risk of stroke in patients who have Atrial Fibrillation or Afib. When the heart beats in an uncoordinated and irregular manner, there is a tendency for the blood within the LAA to pool. In other words, the blood in this pouch is not pumped out and refreshed. Stagnant blood can thicken, harden and ultimately develop into clots. If any of these clots were to break off and move into the cardiovascular system, they could cause a stroke. If not treated immediately, a stroke can be fatal.
You may not have heard of the LAA or its contribution to stroke risk. It is worth noting that for patients with atrial fibrillation, the risk of stroke is about five times higher than someone who does not suffer from Afib. Also of note, the risk of heart attack and long-term heart failure is also significantly increased. More startling, however, is the fact that it is estimated that atrial fibrillation is the direct cause of up to 25% of all strokes in those over 80.
Addressing this potential clotting at the source – the LAA – we can significantly reduce the risk of a patient having a stroke. We can achieve this with a procedure known as LAA closure. Just as it sounds, we seal off the entrance to the LAA and in doing so, trap the clotted blood in a separate chamber from the rest of the heart.
Until relatively recent developments in the field, patients’ only option was anticoagulants, and in some cases, open heart surgery to reduce this risk of stroke. Of course, this created significant risk in and of itself. More recently, medical devices and techniques have been created to close the LAA in a more minimally invasive manner. Dr. Tordini prefers The Watchman Device, which uses an implant to seal off the LAA and in doing so reduces the risk of stroke dramatically. Further, this can be performed in conjunction with a cardiac catheter ablation or balloon cryoablation to eliminate Afib.