What is Left Atrial Appendage Closure Device Implantation

Left atrial appendage (LAA) closure device implantation is a procedure that is done to place a small device in the LAA of the heart. The left atrium is one of the heart’s two upper chambers, and the LAA is a small sac in the wall of the left atrium. The device closes the LAA.

This procedure can help prevent a stroke caused by atrial fibrillation. Atrial fibrillation is a type of irregular or rapid heartbeat (arrhythmia). When the heart does not beat normally and the heartbeat is irregular, there is an increased risk of blood clots and stroke. A blood clot can form in the LAA.

Tell a health care provider about:

• Any allergies you have.
• All medicines you are taking, including vitamins, herbs, eye drops, creams, and over-the-counter medicines.
• Any problems you or family members have had with anesthetic medicines.
• Any blood disorders you have.
• Any surgeries you have had.
• Any medical conditions you have.
• Whether you are pregnant or may be pregnant.

What are the risks?

Generally, this is a safe procedure. However, problems may occur, including:

• Infection.
• Bleeding.
• Allergic reactions to medicines or dyes.
• Damage to nearby structures or organs.
• Heart attack.
• Stroke.
• Blood clots.
• Changes in heart rhythm.
• Device failure.

What happens before the procedure?

Medicines

• Ask your health care provider about:
  • Changing or stopping your regular medicines. This is especially important if you are taking diabetes medicines or blood thinners.
  • Taking medicines such as aspirin and ibuprofen. These medicines can thin your blood. Do not take these medicines unless your health care provider tells you to take them.
  • Taking over-the-counter medicines, vitamins, herbs, and supplements.
• You may be given antibiotic medicine to help prevent an infection.

Staying hydrated

Follow instructions from your health care provider about hydration, which may include:

• Up to 2 hours before the procedure – you may continue to drink clear liquids, such as water, clear fruit juice, black coffee, and plain tea.

Eating and drinking restrictions

Follow instructions from your health care provider about eating and drinking, which may include:

• 8 hours before the procedure – stop eating heavy meals or foods such as meat, fried foods, or fatty foods.
• 6 hours before the procedure – stop eating light meals or foods, such as toast or cereal.
• 6 hours before the procedure – stop drinking milk or drinks that contain milk.
• 2 hours before the procedure – stop drinking clear liquids.

General instructions

• Do not use any products that contain nicotine or tobacco, such as cigarettes and e-cigarettes. If you need help quitting, ask your health care provider.
• You will have blood tests and a physical exam.
• You will have a test called an electrocardiogram (ECG) to check your heart’s electrical patterns and rhythms.
• You may be asked to shower with a germ-killing soap.
• Plan to have someone take you home from the hospital or clinic.
• Plan to have a responsible adult care for you for at least 24 hours after you leave the hospital or clinic. This is important.

What happens during the procedure?

• To lower your risk of infection:
  • Your health care team will wash or sanitize their hands.
  • Hair may be removed from the surgical area.
  • Your skin will be washed with soap.
• An IV will be inserted into one of your veins.
• You will be given one or more of the following:
  • A medicine to help you relax (sedative).
  • A medicine to make you fall asleep (general anesthetic).
• A small incision will be made in your groin area.
• A small wire will be put through the incision and into a blood vessel.
• X-ray dye may be injected so X-rays can be used to guide the wire through the blood vessel.
• A long, thin tube (catheter) will be put over the small wire and moved up through the blood vessel to reach your heart.
• The closure device will be moved through the catheter until it reaches your heart.
• A small hole will be made in the septum (transseptal puncture). The septum is a thin tissue that separates the upper two chambers of the heart.
• The device will be placed so that it closes the LAA. X-rays will be done to make sure the device is in the right place.
• The catheter and wire will be removed. The closure device will remain in your heart.
• A bandage (dressing) will be placed over the site where the catheter was inserted. Pressure will be applied to prevent any bleeding.

The procedure may vary among health care providers and hospitals.

What happens after the procedure?

• Your blood pressure, heart rate, breathing rate, and blood oxygen level will be monitored until the medicines you were given have worn off.
• You may have to wear compression stockings. These stockings help to prevent blood clots and reduce swelling in your legs.
• Do not drive for 24 hours if you were given a sedative. Ask your health care provider when it is safe for you to drive.
• You may be given pain medicine.
• You may need to drink more fluids to wash (flush) the X-ray dye out of your body.
• Take over-the-counter and prescription medicines only as told by your health care provider. This is especially important if you were given blood thinners.

Summary

• Left atrial appendage (LAA) closure device implantation is a surgery that is done to put a small device in one of the heart’s upper chambers (left atrium). The device is placed in a small sac in the wall of the left atrium (left atrial appendage).
• The device closes the LAA to prevent strokes and other problems.
• Follow instructions from your health care provider before and after the procedure.

Left Atrial Appendage Closure Device Implantation, Care After

This sheet gives you information about how to care for yourself after your procedure. Your health care provider may also give you more specific instructions. If you have problems or questions, contact your health care provider.

What can I expect after the procedure?

After the procedure, it is common to have:

• Some pain, swelling, soreness, and bruising around the site where a long, thin tube (catheter) was inserted in your groin (catheter insertion site).
• Tiredness.

Follow these instructions at home:

Catheter insertion area care

• Follow instructions from your health care provider about how to take care of the catheter insertion site. Make sure you:
  • Wash your hands with soap and water before you change your bandage (dressing). If soap and water are not available, use hand sanitizer.
  • Change your dressing as told by your health care provider.
  • Leave stitches (sutures), skin glue, or adhesive strips in place. These skin closures may need to stay in place for 2 weeks or longer. If adhesive strip edges start to loosen and curl up, you may trim the loose edges. Do not remove adhesive strips completely unless your health care provider tells you to do that. Skin glue and adhesive strips usually fall off on their own.
• Check your catheter insertion area every day for signs of infection. Check for:
  • Redness, swelling, or pain.
  • Fluid or blood.
  • Warmth.
  • Pus or a bad smell.
  • A lump or bump that may develop.

Medicines

• Take over-the-counter and prescription medicines only as told by your health care provider.
• If you were prescribed antibiotic medicine, take it as told by your health care provider. Do not stop taking the antibiotic even if you start to feel better.
• You may need to take medicines to prevent blood clots.

Activity

• Do not lift anything that is heavier than 10 lb (4.5 kg), or the limit that you are told, until your health care provider says that it is safe.
• Avoid activity that requires a lot of effort, including exercise and sports, as told by your health care provider. Ask your health care provider what activities are safe for you.
• Avoid sexual activity until your health care provider says that it is safe.
• Do not drive for 24 hours if you were given a medicine to help you relax (sedative) during the procedure. Ask your health care provider when it is safe for you to drive.

Lifestyle

• Limit alcohol intake to no more than 1 drink a day for nonpregnant women and 2 drinks a day for men. One drink equals 12 oz of beer, 5 oz of wine, or 1½ oz of hard liquor.
• Do not use any products that contain nicotine or tobacco, such as cigarettes and e-cigarettes. If you need help quitting, ask your health care provider.

General instructions

• Do not take baths, swim, shower, or use a hot tub until your health care provider approves.
• Follow instructions from your health care provider about eating or drinking restrictions. You may need to follow a diet that is low in salt (sodium) and low in fat to prevent heart problems.
• Keep all follow-up visits as told by your health care provider. This is important.

Contact a health care provider if:

• You have severe pain that does not get better with medicine.
• You have redness, swelling, or pain around your catheter insertion site.
• You have fluid or blood coming from your catheter insertion area.
• Your catheter insertion site feels warm to the touch.
• You have pus or a bad smell coming from your catheter insertion area.
• You have a fever.
• You have nausea and vomiting.
• You develop a lump or bump in your catheter insertion area.

Get help right away if:

• The catheter insertion area is bleeding, and the bleeding does not stop when you apply and hold steady pressure on the area.
• You have chest pain.
• You have trouble breathing.
• You have dizziness.
• You faint.
• You have any symptoms of a stroke. “BE FAST” is an easy way to remember the main warning signs of a stroke:
  • B – Balance. Signs are dizziness, sudden trouble walking, or loss of balance.
  • E – Eyes. Signs are trouble seeing or a sudden change in vision.
  • F – Face. Signs are sudden weakness or numbness of the face, or the face or eyelid drooping on one side.
  • A – Arms. Signs are weakness or numbness in an arm. This happens suddenly and usually on one side of the body.
  • S – Speech. Signs are sudden trouble speaking, slurred speech, or trouble understanding what people say.
  • T – Time. Time to call emergency services. Write down what time symptoms started.
• You have other signs of a stroke, such as:
  • A sudden, severe headache with no known cause.
  • Nausea or vomiting.
  • Seizure.

These symptoms may represent a serious problem that is an emergency. Do not wait to see if the symptoms will go away. Get medical help right away. Call your local emergency services (911 in the U.S.). Do not drive yourself to the hospital.

Summary

• It is common to have some pain and soreness after the procedure.
• Check your catheter insertion area every day for signs of infection, such as redness, swelling, or pain.
• Do not take baths, swim, shower, or use a hot tub until your health care provider approves.