Learn about LAA Closure (Left Atrial Appendage Closure) treatment that reduces the risk of stroke

You may have heard of Atrial Fibrillation (Afib), a condition in which your heart beats irregularly and rapidly. Perhaps you or someone in your family has this condition. The biggest risk of Afib is an increased risk of stroke. As a solution to this, doctors often prescribe blood thinners. But taking these medications long-term is not easy for everyone. For such people, we are talking about a special treatment method that can reduce the risk of stroke.

Simply put, what is Left Atrial Appendage Closure (LAA Closure)?

To understand this, let's first learn about a small part of our heart. In the upper left chamber of our heart, called the Left Atrium, there is a small pouch-like protrusion. This is what we call the Left Atrial Appendage (LAA) .

Normally, when the heart beats in a rhythm, the blood inside this LAA is pumped to the rest of the heart. However, in a person with Atrial Fibrillation (Afib) , the heart beats irregularly, so the blood inside this bag called the LAA does not pump properly and starts to pool. This pooling of blood can eventually turn into blood clots .

Unfortunately, if this clot breaks free and gets stuck in a blood vessel leading to the brain, it can cause a stroke . About 90% of strokes in people with Afib are caused by clots forming in the LAA.

So, in this treatment called LAA Closure, the bag called LAA where blood clots form is closed, either through surgery or through a very small incision. After this is closed, even if blood clots form, they cannot enter the bloodstream. Therefore, the risk of stroke is greatly reduced.

Who is this treatment best for? Why not just use blood thinners?

LAA Closure is not a treatment for everyone who is at high risk of stroke due to Afib. It is especially considered for people who:

• For those who do not want to take anticoagulants for a long time.
• People who fall frequently and are therefore at increased risk of bleeding (because even a small injury can cause major bleeding when taking blood thinners).
• For those who experience other side effects from blood-thinning medications.
• For those who cannot afford the high cost of blood-thinning medications.

Many people face various difficulties when taking old blood-thinning medications like Warfarin.

Although there are newer medications like Apixaban and Rivaroxaban, their high cost and the continued risk of bleeding are issues for some people. You should definitely talk to your cardiologist to decide which treatment is best for you.

What methods are used to close this LAA?

There are various methods and devices for this. Think of it like closing the mouth of a water bottle, this device is used to close the mouth of this bag called LAA.

• Internal occlusion devices: These are like a small umbrella. They are inserted into the heart using a catheter and are used to seal off the opening of the LAA from the inside. WATCHMAN™ and Amulet™ are popular devices of this type.
• External closure devices: Sometimes, during other heart surgery, the LAA can be closed externally with a clip (`AtriClip™`) or with a special suture (`Lariat™`).

The method that is right for you is chosen after a discussion between you and your doctor.

Preparing for treatment and how the treatment takes place

Before treatment...

Before this procedure, your doctor will need to measure the exact size and shape of your LAA. Not everyone's LAA is the same. Some say it's shaped like a chicken wing, a cactus, or a cauliflower. This will involve a Transesophageal Echocardiogram (TEE) (a scan of the heart done through a tube called a larynx) or a Cardiac CT scan. You will also be instructed to fast (not eat or drink) for a few hours before the procedure.

During treatment...

This can be done in two main ways:

1. With other heart surgery: If you are having another major heart surgery, such as a bypass surgery, the surgeon may also remove or sew the LAA closed at the same time.

2. Minimally Invasive: This is the most commonly used method. Here, a thin tube, called a catheter, is inserted through your groin into a vein and guided all the way to your heart. Then, a pre-selected device is placed in the opening of the LAA and sealed to prevent blood clots from escaping. This entire procedure is performed under the guidance of special X-ray (Fluoroscopy) and scan (TEE/Intracardiac Ultrasound) technology.

After treatment...

• Usually you have to stay in the hospital overnight.
• A TEE scan will be done again in about 45 days to see if the treatment was successful.
• You will be given a blood thinner and aspirin to take until the body's tissue grows around this device, which takes about a month and a half.
• After that, you will have to stop taking the blood thinner and take Clopidogrel and aspirin for about 6 months. You may even have to take aspirin for the rest of your life. All of this will be done on the advice of your doctor.

What are the benefits and risks of this treatment?

Like any medical treatment, this one has both benefits and risks.

This treatment is very effective. According to some studies, this method can reduce the risk of stroke by about 80%. But remember, it is essential to discuss all of this with your doctor before deciding whether this is right for you.

When should I see the doctor?

In addition to going to your scheduled follow-up appointments, notify your doctor immediately if you experience the following symptoms:

• Signs of a fever or other infection
• Irregular heartbeat
• Chest pain
• Difficulty breathing

If you experience any of these symptoms, go to the nearest hospital's Emergency Department (ETU) immediately.

Heart disease, Stroke, LAA Closure, Atrial Fibrillation, Afib, Blood clots, Stroke prevention, Heart health