Left atrial appendage (LAA) closure devices are implantable cardiac devices which are placed in the left atrial appendage for stroke prevention in patients with atrial fibrillation who have contraindications to pharmacological anticoagulation. Depending on the device they may be inserted percutaneously or though minimally invasive or open surgery.
Left atrial appendage closure devices occlude the LAA, thereby sealing it off to the blood circulating through the left atrium therefore reducing the risk of thromboembolism from the left atrial appendage 1,2. The Watchman device has shown non-inferiority compared to pharmacological anticoagulation for stroke prevention in atrial fibrillation 3.
Some of the devices available include 1:
- resembles deployed round parachute and consists of titanium frame and plastic cap
- resembles hair pin
- consists of cage and occlusion membrane
- Amplatzer® Amulet
- Amplatzer® Cardiac Plug
- consists of two components - bulb and sail, characteristic appearance of the bulb resembling king's hat may help to distinguish it from other left appendage occlusion devices.
A left atrial appendage closure device should be visible over the expected position of the left atrial appendage. A device that is not visible here could signify migration or improper positioning 3.
- incomplete atrial closure
- pericardial effusion
- 1. Swaans MJ et al, Percutaneous left atrial appendage closure devices: safety, efficacy, and clinical utility. Med Devices (Auckl). 2016; 9: 309–316.
- 2. Onalan O, Crystal E. Left atrial appendage exclusion for stroke prevention in patients with nonrheumatic atrial fibrillation. Stroke. 38 (2 Suppl): 624-30. doi:10.1161/01.STR.0000250166.06949.95 - Pubmed
- 3. Sigakis CJG, Mathai SK, Suby-Long TD, Restauri NL, Ocazionez D, Bang TJ, Restrepo CS, Sachs PB, Vargas D. Radiographic Review of Current Therapeutic and Monitoring Devices in the Chest. (2018) Radiographics : a review publication of the Radiological Society of North America, Inc. 38 (4): 1027-1045. doi:10.1148/rg.2018170096 - Pubmed
- 4, Bedeir K, Warriner S, Kofsky E, Gullett C, Ramlawi B. Left Atrial Appendage Epicardial Clip (AtriClip): Essentials and Post-Procedure Management. (2019) Journal of atrial fibrillation. 11 (6): 2087. doi:10.4022/jafib.2087 - Pubmed