Stroke prevention with left atrial appendage closure (LAAC). Atrial fibrillation is a significant risk factor for stroke because the quivering of the heart’s upper chambers makes it harder for the heart to pump blood. This makes it possible for blood to collect in the left atrial appendage (LAA) of the heart, where blood blots can form. A blood clot that escapes the heart and travels to the brain can cause a stroke. To help prevent the formation of blood clots in people who have atrial fibrillation that can’t be adequately controlled with medications, doctors may recommend a left atrial appendage closure procedure, such as with the WATCHMAN device circled in this diagram. Media provided courtesy of Boston Scientific. © 2015 Boston Scientific Corporation or its affiliates. All rights reserved.

Left atrial appendage closure (LAA closure or LAAC) is a minimally invasive medical technique used to significantly lower the risk of stroke in a patient who has atrial fibrillation (also known as Afib or AF) and for whom other methods of treatment have been unsuccessful. You may be a candidate for this procedure if you have Afib and are unable or unwilling to take blood-thinning medications called anticoagulants.

How LAA Closure Works

LAA closure actually refers to different techniques that close or seal off the left atrial appendage (LAA) of the heart. The LAA is a hollow sac located just off the top chamber of the heart. The LAA serves no known purpose -- much like the appendix. In fact, doctors have found that in people with atrial fibrillation, the LAA can be a source for problems, including blood clots that can form in the LAA and travel to the brain, possibly causing a stroke. Closing off the LAA reduces the risk of blood clots that can lead to stroke and, fortunately, it doesn’t seem to prevent the heart from functioning normally.

LAA closure can be performed using a technique that sews the LAA sac closed (ligation, often with a tool called Lariat) or with a device that plugs the LAA closed (occlusion, with a device called WATCHMAN or with the Amplatzer Cardiac Plug). In both techniques, the goal is to close off the LAA so blood cannot enter the sac and collect there. This strategy eliminates the opportunity for blood to pool and form dangerous clots that could eventually escape the heart and cause a stroke or other dangerous condition. You can learn more about LAA closure and how each device works here.

While LAA closure has been shown to be effective in preventing stroke and reducing the need for blood-thinning medications, it is not for all people who have Afib. In fact, these procedures are recommended only for people in specific situations.

You May Be Eligible for LAA Closure with the LARIAT if ...

• You are unable to tolerate anticoagulant (blood-thinning) medications or continue to have problems with blood clots despite blood-thinners
• You are not a candidate for a more invasive procedure, such as open-heart surgery

You May Be Eligible for LAA Closure with the WATCHMAN or the AMPLATZER Cardiac Plug if ...

• You are seeking alternatives to anticoagulant (blood-thinning) medications
• You are not a candidate for a more invasive procedure, such as open-heart surgery

It is important to note that most people with Afib are not candidates for LAA closure because anticoagulant medications are a better option for them or because their Afib could be better treated with either antiarrhythmic medications or procedures, such as cardioversion or ablation.

More information about LAA closure works can be found in the SecondsCount Center on Left Atrial Appendage Closure, found here.