The left atrial appendage is an outpouching structure connected to the left atrium of the heart (left upper heart chamber). This is a normal heart structure and does not cause problems for most people. However, this can be a source of clot formation in patients with atrial fibrillation (AF) - a form of irregular heart beat.
The prevalence of atrial fibrillation in Singapore is approximately 1.5% but this is likely to increase as the population ages. It is the most common significant type of irregular heart rhythm in Singapore but most importantly, it is the biggest risk factor causing stroke.
During atrial fibrillation, there is ineffective blood flow in the upper heart chambers. This leads to stagnation of blood in the left atrium. It has been shown that the majority of blood clots in patients with atrial fibrillation reside in the left atrial appendage. Current evidence shows that the transcatheter left atrial appendage device closure is effective in reducing the risk of clot related complications associated with non valvular atrial fibrillation.
What are the options available to reduce the risks of stroke in patients with AF?
There are many options available but there is no single option that would be appropriate for every patient. Please discuss this with your doctor. There are however several standard therapeutic options that you should be aware of. These include:
- Administration of blood thinners
- Open surgery to remove the left atrial appendage
- Transcatheter atrial appendage closure
What is transcatheter left atrial appendage device closure?
This is a procedure where devices designed specifically to fit the left atrial appendage is delivered through a catheter (tube) and used to seal the orifice of the atrial appendage. With time, tissue endothelization (growth) would occur over the device and prevent further clot migration.
How is this done?
This procedure is done under general anesthetic in a heart catheterization laboratory. It takes approximately 1-2 hours. Transesophageal echocardiogram (ultrasound) and fluoroscopy (X-ray) are used to monitor the procedure. A soft catheter (tube) is first introduced into the leg vein and then positioned across the atrial septum. The left atrial appendage closure device is then delivered to its intended position and released.
What happens after the procedure?
You would be woken from anesthesia and then transferred to the cardiac monitoring unit for 24 hours. Most patients can be discharged after 2-3 days. The recovery time differs from patient to patient. However, strenuous activities are best avoided for 1 month after the procedure.
What are the risks involved in this procedure?
There are certain potential risks associated with any interventional procedure as well as risks specific to the device. Your doctor is the best person to provide you with accurate information and assessment of these risks. You should speak to him/her to address your concerns fully.
Potential risks include but are not limited to:
- Air embolus
- Allergic drug reaction
- Allergic dye reaction
- Anesthetic reaction
- ardiac arrest
- Cardiac tamponade (bleeding outside the heart between the heart muscle and the lining of the heart)
Device migration or embolization
- Embolic event (where particles of clot/air travel and obstruct blood flow)
Foreign body embolization
- High or low blood pressure
- Heart attack
- Renal failure
- Blood clot formation
- Access site complications, vessel injury
- Valve dysfunction