Left Atrial Appendage (LAA) Closure in Atrial Fibrillation (AF)

1. Rationale and Benefits

• The left atrial appendage (LAA) is a small pouch located in the left atrium of the heart.
• In people with atrial fibrillation (AF), this pouch is where blood clots form most often, responsible for about 90% of stroke-causing clots.
• Left atrial appendage closure (LAAC) mechanically excludesthis area from circulation, helping lower the risk of stroke and potentially reducing the need for long-term blood-thinner medications.
• LAAC is particularly beneficial for:
  • Patients at high bleeding risk(e.g., prior intracranial hemorrhage, recurrent gastrointestinal bleeding).
  • Those with contraindications or intoleranceto long-term blood-thinner medications (e.g., warfarin, DOACs).
• LAAC can be performed surgically(during other cardiac operations e.g., valve replacement or coronary bypass) or percutaneously (minimally invasive, catheter-based).

 

2. Indications

• Blood-thinner medications remains the standard of carefor stroke prevention in AF in most patients.
• For a patient with AF undergoing open-heart surgery (e.g., for valve replacement or bypass), surgical LAAC is supported.
• For percutaneous LAAC in non-surgical patients: the strongest indication is when the patient has AF, a substantial stroke risk, and a contraindicationto long-term blood-thinner medications.
• The level of evidence for percutaneous LAAC is still evolving
• Recent data showed that LAAC in combination with an AF ablation procedure is feasible and safe in selected patients.

 

3. Important Considerations

• LAAC reduces but does not eliminatestroke risk. Patients may still require short-term or modified blood-thinner medications post-procedure.
• LAAC is done through a minimally invasive procedure, and like any procedure, it does come with some However, with today’s advanced tools and techniques, these risks are generally low, including:
  • Cardiac tamponade or pericardial effusion
  • Device embolization or malposition (means the device has moved or is not sitting correctly, and may need to be adjusted or fixed)
  • Air embolism or stroke during the procedure;
  • Vascular access complications;
  • Peridevice leak: A small amount of blood may still flow around the device after it’s placed. Most leaks are small, don’t cause problems, and often improve or close over time.
• Patients’ selection is crucial: LAAC is best suited for carefully selected patients, where the benefit–risk balancefavors LACC over medical therapy. It requires multidisciplinary decision-making (cardiologist, electrophysiologist, stroke specialist, patient preference). To assess whether the anatomy is favorable and to estimate the size of the device, an imaging method will have to be performed prior to the procedure, namely a cardiac CT scan and/or transesophageal echocardiogram.

 

Summary

Potential Benefit	Potential Risk / Concern
Stroke prevention without long-term blood-thinner medications	Procedure-related complications
Useful when blood-thinner medications are contraindicated	Residual risk of stroke or leak
Minimally invasive	Need for temporary post-procedure drugs
Option during AF ablation or surgery	Limited long-term comparative data (but evolving evidence)

 

The content for this website for patients has been reviewed by Dr. Heather Edwards (nominated by the British Heart Rhythm Society (BHRS)).

---