Left Atrial Appendage (LAA)

Left Atrial Appendage (LAA)

Procedures

Symptoms, Treatment & Procedures

Left Atrial Appendage Closure

Left Atrial Appendage (LAA) Closure Device

 

The Left Atrial Appendage is a small sac in the muscle wall of the left atrium. It is unclear what function, if any, the LAA performs.

In normal hearts, the heart contracts with each heartbeat, and the blood in the left atrium and LAA is squeezed out.

In Atrial Fibrillation – which is an irregular and chaotic heart beat. Those beats do not allow the atria to contract and effectively squeeze the blood out. This is how the blood collects inside the LAA and forms a clot which then can cause a stroke. Studies have shown that, in patients who do not have valve disease, the majority of blood clots that occur in the left atrium start in the LAA.

Anticoagulation such as warfarin or the NOACs (Eliquis, Xarelto, Pradaxa) are used to reduce the risk of clot formation.

The Left Atrial Appendage Closure Device
Help for patients with atrial fibrillation who require an alternative to long-term anticoagulation (warfarin or NOAC) therapy through a minimally invasive procedure.

INTENDED USE/INDICATIONS FOR USE

The LAA closure device such as the WATCHMAN FLX or AMULET Device is indicated to reduce the risk of thromboembolism from the left atrial appendage in patients with non-valvular atrial fibrillation who:

  • Are at increased risk for stroke and systemic embolism based on CHADS2 or CHA2DS2-VASc scores and are recommended for anticoagulation therapy;
  • Are deemed by their physicians to be not suitable for anticoagulation therapy; and/or
  • Have an appropriate rationale to seek a non-pharmacologic alternative to anticoagulation therapy, taking into account the safety and effectiveness of the device compared to anticoagulation therapy.

PATIENT SELECTION FOR TREATMENT

In considering the use of the LAA Closure Device, the rationale for seeking an alternative to long-term anticoagulation therapy and the safety and effectiveness of the device compared to anticoagulation should be taken into account.

  • The presence of indication(s) for long-term anticoagulation therapy, other than non-valvular atrial fibrillation (e.g. mechanical heart valve, hypercoagulable states, recurrent deep venous thrombosis) deems the device unsuitable for those conditions.

Watchman Device Sizes

  • The Watchman Device is available in 5 sizes from 21 to 33 mm and is designed to be permanently implanted.

A/Prof Peter Fahmy performs a procedure for the first time in NSW.

The procedure used a new, next generation, self-expanding device called the WATCHMAN FLX to perform a left atrial appendage (LAA) closure; a minimally invasive procedure to reduce the risk of stroke.

Left Atrial Appendage Closure A/Prof Peter Fahmy

Watchmen Implantation
Procedure Video

The Watchman device prevents strokes in atrial fibrillation patients by closing the left atrial appendage to prevent blood clots. Watch this video to see how it works.

 A/Prof Peter Fahmy's Cardiology Treatments

TAVI (Tranascatheter Aortic Valve Insertion)

Transcatheter aortic valve implantation (TAVI) is a procedure that allows an aortic valve to be implanted using a long narrow tube called a catheter. Usually, the catheter is inserted into a large blood vessel in your groin or through a small incision in your chest.

Percutaneous Coronary Intervention (PCI)

Percutaneous Coronary Intervention (PCI) is sometimes called, an angioplasty with stent. PCI is a non-surgical procedure that uses a catheter to place a stent in the blood vessel of the heart that has been narrowed by plaque build-up.

Adjunctive imaging can also be used to further assist in coronary intervention such as IVUS and OCT.

Diagnostic imaging such as Intravascular Ultrasound (or IVUS) lets cardiologists see inside a coronary artery in real time, yielding information beyond routine imaging methods such as coronary angiography or non-invasive Multislice CT scans.

Intravascular optical coherence tomography (OCT) can add value to angiography as a diagnostic and/or intervention tool for percutaneous coronary intervention (PCI) guidance.

Rotablation

This is a procedure which attempts to “bore out” a narrowing in a coronary artery which might not otherwise respond to stenting.

Intravascular Ultrasound

Intravascular Ultrasound (or IVUS) lets cardiologists see inside a coronary artery in real time, yielding information beyond routine imaging methods such as coronary angiography or non-invasive multislice CT scans.

Patent Foramen Ovale (PFO)

The heart is divided into four chambers. The upper chambers are called the right and left atria. The lower chambers are the right and left ventricles. In fetal circulation, the foramen ovale is an opening that allows blood to bypass the lungs and go directly from the right atria to the left atria. Shortly after birth, the higher pressure in the left atria and the lower pressure in the right atria causes permanent closure of the foramen ovale in the majority of people. A PFO occurs when the opening does not close. This opening can allow blood to pass from the right atria to the left atria. Many times a PFO is not discovered until adulthood.

PFO’s are suspected to be a cause of cryptogenic stroke (a stroke that cannot be linked to a specific cause). Some research suggests there may be a link between PFO’s and migraine headaches.

Atrial Septal Defect (ASD)

An ASD is a hole in the part of the septum that separates the atria—the upper chambers of the heart. This heart defect allows oxygen-rich blood from the left atrium to flow into the right atrium instead of flowing to the left ventricle as it should. Many children who have ASDs have few if any, symptoms.

Ischemic Heart Disease

Ischemic heart disease occurs when there is reduced blood supply to the heart.

Structural Heart Disease (SHD)

People with structural heart disease fall into two categories:

  1. People are born with the disease – i.e. a hole within the chambers of the heart
  2. They acquire  SHD through wear and tear – i.e. a tight or leaky heart valve.
Heart Failure

Heart failure occurs when the heart muscle has become too weak or too stiff to pump blood through the body as effectively as normal.

Arrhythmias

Heart arrhythmia refers to a group of symptoms where the heartbeat is irregular, too slow, or too fast. Arrhythmias are broken down into:

  • Slow heartbeat (bradycardia).
  • Fast heartbeat (tachycardia).
  • Irregular heartbeat (flutter or fibrillation).
  • Early heartbeat (premature contraction).