The left atrial appendage is a small pouch attached to the left atrium, one of the heart's upper chambers. It's a normal part of the heart. In atrial fibrillation (AF), the upper chambers don't squeeze in a coordinated way. Blood can collect in this pouch and form a clot. If a clot travels to the brain, it can cause a stroke.
Closure blocks the pouch's opening so clots inside it are less likely to enter the bloodstream. You may also hear it called left atrial appendage occlusion, or LAAO. It doesn't correct AF or remove every possible cause of stroke.
Call triple zero (000) for severe, worsening or persistent chest pain, or chest discomfort with breathlessness, sweating, nausea or pain spreading to your arm, jaw or back.
Do not wait for a routine appointment or drive yourself to hospital.
Catheter closure commonly uses general anaesthesia, so you're asleep. The doctor passes a thin tube called a catheter through a vein in your groin and into the heart, then makes a small opening in the wall between the upper chambers so the catheter can reach the left atrium.
A small closure device travels through the catheter to the appendage. It expands at the pouch's entrance and blocks it, forming a barrier between the pouch and blood flowing through the left atrium. The pouch itself stays in place.
X-ray and ultrasound images guide placement. The ultrasound views may come from a transoesophageal echocardiogram (TOE), with a probe passed down the food pipe behind your heart. These images let the doctor check the device's position and seal before releasing it. The catheter is then removed, but the device stays inside the heart, and tissue gradually grows over its surface.
If you have AF and already need heart surgery, the surgeon may discuss closing the appendage during that operation. A surgical clip or stitches can close it off, or it may be removed and the opening closed. Recovery depends on the heart operation you're having.
Many people with AF take an anticoagulant, commonly called a blood thinner, to lower their risk of stroke. Closure may be an option if your stroke risk warrants treatment but you can't safely take an anticoagulant over the long term, for example because of serious bleeding.
The cardiologist weighs your chance of a stroke against your chance of bleeding. A previous bleed doesn't automatically mean you need closure. Sometimes its cause can be treated, or your medicine can be changed. The risks of having a procedure also need to be weighed against continuing medicines.
Closure isn't suitable for everyone with AF. Heart scans help the hospital specialist check whether the shape of your appendage will suit a closure device and whether there's already a clot. The specialist also checks whether you can take the medicines needed after the device is fitted.
Clots can form on the surface of a newly fitted device before tissue grows over it. You may need an anticoagulant or an antiplatelet medicine to lower this risk. These medicines can be needed even when avoiding long-term anticoagulants was the reason for considering closure.
The hospital specialist chooses the medicines and how long to take them based on the device, your bleeding risk and follow-up scan results. Don't stop or change them without the treating doctor's advice. Closure during heart surgery also doesn't automatically mean anticoagulants can stop.
Medicines to slow or control your heartbeat may still be needed. Cardioversion or ablation treats the heart rhythm, whereas appendage closure is meant to lower the risk of a stroke from clots in the pouch. Blood pressure treatment and care for other conditions remain part of reducing stroke risk. These decisions can be discussed together in a consultation about AF.
A TOE may also be used before closure to check for existing clots. The hospital gives instructions about eating, drinking and your usual medicines, and explains the anaesthetic plan. Tell staff about allergies and any previous problems with an anaesthetic.
After catheter closure, staff monitor your heart and check the groin puncture site, where some bruising can occur. If a TOE probe or an anaesthetic breathing tube was used, your throat may feel sore afterwards. Before you leave, confirm how to care for the wound, when you can return to driving and activity, and who to contact if a problem develops. Plan for someone to take you home.
Follow-up imaging checks the device's position and the seal around it. A gap can remain, or a clot can form on the device. These findings may change your medicines or mean more treatment is needed.
Risks include bleeding, damage to a blood vessel or the heart, and the device moving from its intended position. Serious complications include stroke or a need for emergency surgery, and some can be life-threatening. Your specialist should explain your individual risk and what the alternatives would mean for you.
Your GP or specialist can refer you to a Heartscope cardiologist to discuss AF, stroke risk and whether referral for appendage closure is appropriate. The clinic can answer questions about the consultation.
Consultations are privately billed. If you're eligible, Medicare pays part of the consultation fee when you have a valid referral from your GP or specialist. The clinic will confirm the amount left to pay before the visit.
Hospital, procedure and related test fees are separate from the Heartscope consultation. The hospital or treating provider confirms those costs before treatment.
Heartscope cardiologists see patients at clinics in Melbourne and Queensland. If you have a referral, our team can confirm the location and appointment details.
View clinic locationsNo. It's done in hospital. Heartscope cardiologists may be able to see patients with a valid referral from their GP or specialist, and can refer you to a hospital heart specialist when appropriate.
No. Appendage closure seals a pouch attached to one chamber. PFO or ASD closure treats an opening between the heart's upper chambers.
It's intended to remain in the heart permanently. Follow-up checks confirm how it's sitting and whether the opening is sealed.
Call triple zero (000) immediately for sudden facial drooping, arm weakness or difficulty speaking, even if symptoms disappear. This advice stays the same after closure, which reduces one particular source of stroke risk.
.png)
.png)
.svg)
