Left Atrial Appendage Occlusion

Left Atrial Appendage Occlusion

Atrial fibrillation and the left atrial appendage

Left atrial appendage occlusion is only relevant to you if you have atrial fibrillation which may be paroxysmal (occurs from time to time) or persistent/permanent. As you may know, patients with atrial fibrillation have an increased risk of stroke compared to someone without atrial fibrillation. We calculate stroke risk for each patient using a scoring system (called the CHADSVASC score) and in those who have a high enough score we recommend taking blood thinning agents called anticoagulants to reduce the risk of stroke.

Why do patients with atrial fibrillation have a higher risk of stroke?

Atrial fibrillation is a common heart rhythm problem that means the atria (the filling chambers of the heart) do not pump in a co-ordinated way, which means blood flows slowly and can form clots. These clots can then cause a stroke. The place these clots form is usually in the left atrial appendage.

What if I cannot take blood thinning medication?

Some patients cannot take blood thinning medication for some reason. Either because they have had bleeding problems in the past (such as a bleed in the brain, gut, bladder or very severe nosebleeds) or because they are at increased risk of falls. In such patients we may recommend left atrial appendage occlusion.

What is left atrial appendage occlusion?

It is a procedure where we put in a small plug in the left atrial appendage to seal it off, and prevent blood flow in or out. Blood clots then cannot form in the left atrial appendage and be released into the circulation, so your stroke risk is reduced. The procedure is done under general anaesthetic usually as a day case procedure. We use one of the veins in the groin to implant the device. It is a low risk procedure and we will discuss your specific risks in detail with you.

What device do you use?

There are various devices available, and usually they are soft metal mesh plugs that are designed to conform to the shape of the mouth of the left atrial appendage and seal it. The most commonly used are the Watchman device and the Amulet device. You will sometimes hear this procedure called a Watchman or Amulet procedure - this means the same thing as left atrial appendage occlusion.

Will I feel any different afterwards?

This is an important point - no, you will not. This procedure is aimed at addressing your stroke risk. It will not make any difference to your atrial fibrillation.

What experience does Dr Dawkins have in the left atrial appendage occlusion procedure?

Dr Dawkins is the Clinical Lead for Structural Intervention in Oxford and left atrial appendage occlusion is one of the procedures he frequently carries out. He trained in the technique in Oxford and then he spent two years working at Cedars Sinai Medical Center in Los Angeles which he gained experience in using Watchman, Amulet and various other left atrial appendage occlusion devices. He was one of the operators for the first Watchman Flx (the new version of Watchman) procedure in the United States, and he then brought this technology back to the UK, doing the first Watchman Flx procedure in the UK.

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