Left atrial appendage occlusion or closure
What Is Left Atrial Appendage Occlusion?
Left Atrial Appendage Occlusion (LAAO), or closure, is a minimally invasive procedure done to reduce the risk of stroke in people with atrial fibrillation (AFib) who cannot take blood thinners long-term. The left atrial appendage is a small sac in the upper chamber of the heart where blood clots tend to form in AFib patients. Closing it off helps prevent those clots from entering the bloodstream and causing strokes.
Why do I need this procedure?
Doctors may recommend LAAO if you have:
Atrial fibrillation not caused by heart valve disease (non-valvular AFib)
A high risk of stroke (as determined by CHA₂DS₂-VASc score)
Bleeding complications from long-term use of blood thinners like warfarin or DOACs
History of gastrointestinal bleeding or falls
Difficulty maintaining stable INR levels (if on warfarin)
Kidney disease or other contraindications to anticoagulation
This procedure provides an alternative to lifelong anticoagulation, lowering stroke risk without increasing bleeding risks.
What happens during the procedure?
LAAO is performed in a cardiac cath lab under general anesthesia. The steps include:
Inserting a catheter through a vein in the leg and guiding it to the heart
Using transesophageal echocardiography (TEE) and fluoroscopy for imaging
Deploying a device (e.g., Watchman, Amulet) to seal off the left atrial appendage
Checking device placement and ensuring proper closure before completing the procedure
The entire procedure typically takes 1 to 2 hours, and most patients go home the next day.
What might I feel?
Slight discomfort from anesthesia and throat soreness if TEE is used
Minor bruising or tenderness at the catheter insertion site
Fatigue or mild chest pressure post-procedure
Most patients experience minimal pain and a quick recovery.
What happens after the procedure?
You will be monitored for a few hours or overnight in a recovery area
Imaging tests may be done to confirm device position
Short-term blood thinners or aspirin may be prescribed for a few weeks
Follow-up imaging (usually TEE) at 45 days to assess closure success
Your cardiologist will review the results and long-term care plan
This procedure significantly reduces stroke risk in AFib patients and helps avoid the long-term use of blood thinners.