A solution to blood clots in the heart? (Left Atrial Appendage Closure) Let's learn about it simply!

Have you been told by your doctor that you have Atrial Fibrillation, an abnormally fast heartbeat? You probably know that people with this condition are three to five times more likely to have a stroke than others. The main reason for this is blood clots that form inside the heart. So today we are talking about a special treatment that has brought great relief to many people and is used to reduce this dangerous risk.

Simply put, what is Left Atrial Appendage Closure?

Okay, this may sound like a complicated name, but the story is very simple. Think of the left atrium, the upper chamber of our heart. There is a small pouch-like part that protrudes from the wall of this chamber. That's what doctors call the Left Atrial Appendage (LAA) .

Normally, when the heart beats properly, blood flows into this sac and then out again. But in a person with Atrial Fibrillation (Afib), the upper chambers of the heart do not contract properly, but instead quiver. Then, blood accumulates in that sac called the LAA, and blood clots begin to form. 90% of the blood clots that cause strokes in people with Afib form in this little sac called the LAA.

The best thing is that closing this part of the LAA does not affect the rest of the heart's function. The heart can function just fine without it.

Who needs this treatment?

This treatment is mainly recommended for people with Atrial Fibrillation (Afib) who are at high risk of stroke. It is especially a good solution for those who have problems with blood thinners.

Doctors often prescribe blood thinners like warfarin (Coumadin®) to reduce the risk of stroke. But some people have problems with these medications:

• Regular blood tests: You need to have regular blood tests to make sure you are taking the right dose of medication.
• Diet control: Some foods, such as vegetables containing vitamin K, may need to be limited.
• Risk of bleeding: This medication may slow the bleeding process even from a minor injury. This is dangerous for someone who falls frequently or is at risk of bleeding from the intestines.
• This medicine doesn't work for some people.

Apixaban (Eliquis®), rivaroxaban (Xarelto®) without warfarinAlthough there are new medications like these, they don't work for everyone. They are expensive for some people, and they also carry a risk of bleeding.

So, for those who find it difficult to continue taking blood-thinning medications for reasons like these, you can talk to your doctor about a treatment called LAA Closure.

What methods are used to close the LAA?

There are various methods and devices to close this part of the LAA. Some of these are:

Preparing for and performing the treatment

Before treatment

Before you undergo this treatment, your doctor will examine your heart with a Transesophageal Echocardiogram (TEE).A scan called a TEE or a cardiac CT scan is done. A TEE involves inserting a small camera down the esophagus to measure the exact shape and size of the LAA in the heart. This is because not everyone's LAA is the same. Some people's LAAs are shaped like a chicken wing, while others' LAAs are shaped like a butterfly. This scan is used to choose the right device and size for you.

In addition, you will be advised to stop eating and drinking (fasting) for a few hours before the treatment.

During treatment

There are two main ways to do this.

1. Performing it at the same time as other heart surgery: If you are having another major heart surgery, such as a bypass surgery, the surgeon may cut and remove this part of the LAA at the same time, or sew it closed.

2. Minimally Invasive: This is the most common method. There is no large incision here. This is what happens:

• A small incision is made in the skin near the groin, and a thin tube called a catheter is passed through a blood vessel there to the heart.
• This tube is inserted from the right atrium of the heart to the left atrium, through a small hole in the wall between the two chambers. (Don't worry, this hole usually closes on its own within 6 months).
• The tube is then advanced to the LAA, and the previously selected device is forced to close the mouth of the LAA.
• All of this is done by looking inside with scans like Fluoroscopy (X-ray video) and TEE .
• When the work is finished, the catheter is taken out.

What happens after treatment?

If this treatment is done through a small incision, you will probably only have to stay in the hospital for one night and will be able to go home the next day.

The medication plan will change a bit after you go home.

• Typically, for the first 45 days , you will be told to take an anticoagulant and aspirin. During that time, skin tissue will form around the device, sealing it tightly.
• Once a TEE scan after 45 days confirms that the LAA is completely closed, you can stop taking blood thinners. You will then be given clopidogrel (Plavix®) and aspirin for 6 months .
• Sometimes the doctor advises taking aspirin long-term.

What are the benefits and risks?

As with any medical treatment, there are benefits and minor risks. Your doctor will explain all of these to you.

When do you need to talk to the doctor?

If you experience any of the following symptoms after going home after treatment, notify your doctor immediately.

• Fever or other signs of infection (swelling, redness of the incision).
• An abnormal heartbeat, a feeling of fluttering in the chest.
• Severe chest pain.
• Difficulty breathing.

Living with Afib can be stressful, especially if you have problems with your blood thinners. LAA Closure is not for everyone, but it may be an option for you. So be open about it with your cardiologist, ask your questions, and make the decision that's best for you.