Risks

Although there are several different left atrial appendage closure (LAAC) methods to treat atrial fibrillation (Afib), it’s important to remember that none of them actually cure Afib. If you undergo LAAC, you’ll still need to work with your doctor to manage the symptoms of Afib. LAAC procedures also don’t totally eliminate the possibility of blood clots. LAAC procedures are effective because they eliminate the possibility of blood collecting in the left atrial appendage (LAA), which is where most Afib-related blood clots form. Nevertheless, blood clots can still form elsewhere in the body and cause stroke or other problems.

It's also important to understand that all procedures include the risk of complications. This means that during or after the procedure, a problem could develop. If you’re considering a LAAC procedure (or any procedure or surgery), you’ll want your doctor to explain what the possible complications are, how often they occur, and specifically how likely they are to occur in a patient like you.

Ligation

One method for closing off the LAA is with ligation, where the opening to the LAA sac is closed by tying a loop around the opening and then tightening it until no blood can get in or out of the LAA. There are two types of LAA ligation: pericardial ligation, a minimally invasive procedure where the heart is accessed through tiny tubes called catheters, and surgical ligation, performed during open-heart surgery where your surgeon stitches the LAA closed.

Risks of a pericardial ligation LAAC

At the beginning of the procedure, a transesophageal echocardiogram (TEE) will be performed to ensure there is no blood clot in the heart; however, it’s possible that during the procedure, a blood clot or air embolus could form in the catheter and be injected into the heart. If this travels to the brain, it could cause a stroke. Your doctor will be aware of this risk and will take steps to minimize this risk.
It’s possible that the LAA could rupture while the device is deployed, which would require emergency heart surgery to repair.
There’s a risk of infection at the two access sites where catheters are inserted into the blood vessels that lead to the heart.
Many people will need to be treated for pericarditis, an inflammation of the pericardial sac around the heart.
Most people must continue taking aspirin after the procedure.

Risks of a surgical ligation LAAC

As with all surgical procedures, there is risk for infection.
Most people probably will have to continue taking aspirin.
Recovery from open-heart surgery takes time, often weeks. (Cardiac rehabilitation is recommended for most people because it supports recovery and promotes heart-healthy habits.)

Occlusion

Another LAAC method is called occlusion (or closure). This technique involves implanting a small device in the opening of the LAA sac so no blood can flow in or out. Over time heart tissue forms over and around the device, permanently sealing off the opening to the LAA and completely preventing blood from getting in and clotting. Two devices are currently available: the WATCHMAN and the AMPLATZER Cardiac Plug. The U.S. Food and Drug Administration (FDA)-approved WATCHMAN device¹ is delivered to the heart through a blood vessel, which means that open-heart surgery is not required. The AMPLATZER Cardiac Plug² is also delivered through a blood vessel to the heart, where it’s positioned to close off the LAA. This device was originally intended to close holes in the wall between the heart chambers; however, it’s been successfully used to close off the LAA as well, though this device isn’t yet approved by the FDA for this purpose.

Risks of a LAAC with the WATCHMAN

It’s possible that the LAA could rupture while the device is deployed, which would require emergency heart surgery to repair.
There’s a risk of infection at the access site where the catheter was inserted into the blood vessel that leads the heart.
Most people probably will have to continue taking aspirin.

Risks of a LAAC with the AMPLATZER cardiac plug

There’s a risk of infection at the access site where the catheter was inserted into the blood vessel that leads the heart.
Most people probably will have to continue taking aspirin.

LAA clamping

Another approach to preventing blood from clotting in the LAA is clamping shut the LAA sac. Your heart surgeon may elect to clamp the LAA shut during an operation to bypass blocked arteries or replace a heart valve, or during another surgery on the heart.

Risks of an LAA amputation

There’s a risk for infection.
Most people probably will have to continue taking aspirin.
Recovery from open-heart surgery takes time, often weeks

Left Atrial Appendage Closure (LAAC)