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Left Atrial Appendage Closure

 

Figure 1: The left side of the heart. The left atrial appendage(*) is a small pouch which connects and drains into the left atrium (LA), the top chamber of the heart.

The left atrial appendage is a small pouch, shaped like a windsock, which empties into the left atrium, one of the top chambers of the heart (Figure 1).  There is no known function for the appendage, similar to the appendix in the belly that is associated with appendicitis.

When patients have a normal heart rhythm, the atrial appendage squeezes rhythmically with the rest of the left atrium.  In doing so, all of the blood in the pouch is ejected into the left atrium, and is pumped all over the body, to the muscles, to the organs and to the brain with the rest of the blood from that chamber. 

Atrial fibrillation is a common rhythm disturbance in older patients in which the top chambers of the heart do not beat regularly. When the left atrial appendage does not squeeze consistently the blood inside the pouch becomes stagnant and may form clots.  These clots may be ejected into the left atrium, and travel  to  the  brain  causing  a  stroke.   In patients with atrial fibrillation, it is estimated that the clots causing stroke originate in the left atrial appendage 90% of the time (Article 1).

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Figure 1:  The left side of the heart.  The left atrial appendage(*) is a small pouch which connects and drains into the left atrium (LA), the top chamber of the heart.

Once atrial fibrillation develops, most patients are required to take blood thinners, usually warfarin (Coumadin), for the rest of their lives (Article 2) to prevent blood clot formation.  This is a difficult medication to take.  Dietary restrictions are necessary (no green vegetables), the dose of the medication may need to be changed frequently, and blood testing is required at least monthly.  While taking warfarin, significant bleeding risks exist, especially as patients get older (Article 2). 

A recent medical study, the PROTECT AF Trial (Article 3, Article 4), tested the theory that closing the left atrial appendage with a plug (Watchman Device – Figure 3a), inserted during a non-surgical catheter procedure, would be as effective as warfarin in reducing the risk of stroke.  Over a period of only a few years, researchers showed that the risks of stroke and other complications of atrial fibrillation were significantly reduced in patients who received the closure device compared with other patients who stayed on warfarin.  Early in the trial, there were some complications of the procedure (like with any operation of this type).  These risks decreased significantly as the doctors developed more experience with the procedure (Article 5). 

figure 3

Figure 3:  Three devices currently being tested for left atrial appendage closure.  The Watchman Device (a); the ACP Device (b); the WaveCrest Device (c). A cartoon representation of the plug being inserted in to the left atrial appendage(*). LA = left atrium.

If you have atrial fibrillation, and are taking warfarin (Coumadin) ask your doctor about these studies, and whether you might benefit from getting off the blood thinners.  Or leave your contact information on our registration form and one of our doctors or nurses will contact you.

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