Left Atrial Appendage Closure

Stroke Prevention for Patients with AFib

Beth Israel Deaconess Medical Center (BIDMC) electrophysiology specialists use implant devices to help reduce risk of stroke for people with atrial fibrillation (AFib). AFib is a type of arrhythmia, or abnormal heart rhythm. 

Understanding the Left Atrial Appendage

The left atrial appendage (LAA) is a small sac located in the muscle wall of the heart’s left atrium (top chamber of the heart). If you have AFib, the electrical impulses that carefully control heartbeats fail to follow their normal orderly route through the heart. 

Instead, impulses may become rapid and chaotic. This prevents the heart’s atria from properly contracting, as it usually does with each heartbeat. This means that the atria do not effectively squeeze blood out to the heart’s bottom chamber to collect in the pouch-like LAA. 

Left Atrial Appendage Occlusion Procedure

An LAA occlusion procedure seals off the left atrial appendage with a self-expanding device. This prevents blood from pooling and prevents blood clots from forming. As a result, your risk of stroke reduces. You also may no longer need to take blood-thinning medication.

One of the implantable devices that the U.S. Food and Drug Administration (FDA) has approved to close the LAA is the Watchman. This parachute-shaped device closes off the LAA. It reduces the risk of blood clots forming if you have AFib.

Studies have shown that the Watchman device can be a good alternative treatment for people with AFib who cannot tolerate treatment with the blood thinner Warfarin.

How the Watchman Procedure Works

The specialist implants the Watchman device percutaneously (through the skin) in the Electrophysiology Lab at BIDMC.

The procedure does not require surgery, but you'll be under general anesthesia (fully asleep). You'll stay in the hospital overnight.

For this procedure, a member of your care team inserts a catheter sheath in a vein near your groin. We guide the catheter across the heart's septum (the muscular wall that divides the right and left sides of the heart) to the opening of the LAA\. We place the Watchman device at the opening, which seals off the LAA and prevents it from releasing blood clots.

Taking Blood Thinning Medication

If you choose a Watchman implant, you need to be able to tolerate anti-coagulation (blood thinning) medication for a short period of time. This can be up to three weeks before your scheduled procedure.  

You’ll continue to take anti-coagulation medication when you leave the hospital until your post-procedure imaging test (transesophageal echo) 45 days later. If the imaging test is normal, then you will transition to dual anti-platelet medication. About six months after the procedure — and if the implant site has sealed — you’ll transition from anti-coagulation medication to aspirin.