If you are one of the 2.7 million people living with atrial fibrillation (also known as Afib or AF), then you’ve probably talked with your healthcare team about the importance of taking care of yourself and managing your risk factors for cardiovascular disease and especially for stroke. Concerns about stroke are especially important because Afib is both a form of heart disease in and of itself and a major risk factor for ischemic stroke.

With all of this information, it’s likely you have at least started discussing treatment options available for managing your Afib symptoms and for reducing your stroke risk. Keep these conversations going! No matter what treatment pathways you and your team decide to follow, the conversations you have together – now and in the future – are essential for protecting your health and ensuring you are feeling well and able to enjoy your life.

Treatment for atrial fibrillation typically focuses on two goals: 

• Reducing Afib events, and
• Preventing stroke.

Let’s briefly review each goal.

Reducing Atrial Fibrillation Events

Afib events occur when the upper chambers of your heart (the atria) receive erratic electrical signals from the heart’s “pacemaker” (the sinoatrial node) and begin to quiver (fibrillate). These episodes can be alarming and uncomfortable and they require medical attention. A big part of your treatment plan may be focused on preventing those episodes from happening. For many people, lifestyle changes and medications can be used to control the Afib episodes. If the medications don’t work or if taking them causes other problems for you, your doctor may recommend a procedure or surgery.

Preventing Stroke

If you have Afib, preventing a stroke is a very important priority. People with Afib are five times more likely to have a stroke that people who don’t have Afib. That’s why medications, specifically blood-thinners (anticoagulants) are a crucial part of Afib treatment. If you have Afib, it’s very likely that your doctor has prescribed warfarin (Coumadin) or another anticoagulant medicine to help prevent your blood from clotting. Blood clots are dangerous because they can travel through the arteries to the brain, where they can block blood flow. When blood can’t get to the brain, it is called an ischemic stroke. The brain tissue is starved of the oxygen it needs and begins to die. A stroke can cause disability or even death. Everyone should know the symptoms of a stroke and when to call 9-1-1. Learn about F.A.S.T. – a tool to help us remember stroke symptoms – here.

Anticoagulant medications work well for many people with Afib, but they are not right for everyone. For one thing, taking an anticoagulant increases bleeding. For some people the medications can cause bruising and nosebleeds or they can cause bleeding inside the digestive tract or even a hemorrhagic stroke. Other people struggle to take anticoagulants because of side effects or because getting the dosage just right can be challenging and, depending on the medication, may require regular blood tests. You can learn more about how doctors assess the risks of taking anticoagulants versus the risks of having a stroke here.

A new procedure, approved the U.S. Food and Drug Administration in 2015, provides an alternative to taking anticoagulant medications for people who have atrial fibrillation and need an alternative to anticoagulants. This procedure, called left atrial appendage closure (LAAC), helps prevent stroke by sealing off a small, unnecessary section of the heart called the left atrial appendage (LAA). For people with Afib, most strokes get their start in the LAA because that is where blood clots tend to form.

LAA closure procedures have been proven to reduce stroke for Afib patients who are unable to take anticoagulant medications. But, like all medical procedures, they are not for everyone. As in all treatment decisions, the key is to work with your healthcare team to understand your condition as well as the benefits and risks of all of your treatment options. Often the decision you make is about assessing the different risks and seeing how they balance out with the benefits you stand to gain as well as with your treatment goals.

Left Atrial Appendage Closure:  Benefits & Risks of Each Option

There are different LAA closure methods. All are performed under general anesthesia, meaning the patient is asleep during the whole procedure.

First, it is important to remember that left atrial appendage closure procedures do not cure Afib. If you undergo LAAC, you will still need to work with your doctor to manage the symptoms of Afib. LAAC procedures also do not totally eliminate the possibility of blood clots. LAAC procedures are effective because they eliminate the possibility of blood collecting in the left atrial appendage, which is where most Afib-related blood clots form. Nevertheless, blood clots can still form elsewhere in the body and cause stroke or other problems.

Second, it’s important to understand that all therapies have both benefits and risks, and all procedures have include the risk of complications. This means that during or after the procedure, a problem could develop. If you are considering a left atrial appendage closure procedure (or any procedure or surgery), you will want your doctor to explain what the possible complications are, how often they occur and specifically how likely they are to occur in a patient like you.

Now, let’s look at the risks and benefits of the different types of LAA closure.  

Ligation

One method for closing off the left atrial appendage is with ligation, where the opening to the LAA sac is closed by tying a loop around the opening and then tightening it until no blood can get in or out of the LAA. There are two types of LAA ligation. Pericardial ligation is a minimally invasive procedure, where the heart is accessed through tiny tubes called catheters. Much like getting a stent, pericardial ligation allows your doctor to treat your heart without open-heart surgery. Surgical ligation takes place during open-heart surgery. If you are having coronary bypass surgery or heart valve surgery, your surgeon may stitch the LAA closed as part of your operation. For more details about how pericardial and surgical ligation are performed, click here.

What Are the Benefits & Risks of Pericardial Ligation?

The benefits and risks of any procedure are always unique to the individual, but there are some general guidelines that apply to most patients.

What Are the Benefits & Risks of Surgical Ligation?

Like any operation, open-heart surgery carries risks. Some people are not strong or healthy enough to undergo open-heart surgery. Your medical team will evaluate your specific situation and advise you about your treatment options.

Occlusion

Another LAA closure method is called occlusion (or closure). This technique involves implanting a small device in the opening of the left atrial appendage sac so no blood can flow in or out. Over time heart tissue forms over and around the device, permanently sealing off the opening to the LAA and completely preventing blood from getting in and clotting. Two devices are currently available.

The WATCHMAN device was approved by the U.S. Food and Drug Administration (FDA) in 2015. It is shaped like a tiny umbrella. Once it place, it is about the size of a quarter. The WATCHMAN is delivered to the heart through a blood vessel, which means that open-heart surgery is not required. You can see a video animation of a WATCHMAN implantation here.

The other device, called the AMPLATZER Cardiac Plug, is also delivered through a blood vessel to the heart, where it is positioned to close off the LAA. This device was originally intended to close holes in the wall between the heart chambers; however, it has been successfully used to close off the left atrial appendage as well. This device is not yet approved by the FDA for this purpose. More information about the AMPLATZER Cardiac Plug is available here.

What Are the Benefits & Risks of LAA Closure with WATCHMAN?

LAA occlusion procedures carry both benefits and risks, depending in part on your unique circumstances and your goals for treatment.

What Are the Benefits & Risks of LAA Closure with AMPLATZER Cardiac Plug?

Amputation of the Left Atrial Appendage

Another approach to preventing blood from clotting in the LAA is completely removing the left atrial appendage sac. Your heart surgeon may elect to remove the left atrial appendage during an operation to bypass blocked arteries or replace a heart valve, or during another surgery on the heart.

What Are the Benefits & Risks of LAA Amputation?

One benefit of LAA amputation is that it can be performed as part of another surgery. However, there are many factors to take into consideration rather than simply convenience. Like any operation, open-heart surgery carries risks. Some people are not strong or healthy enough to undergo open-heart surgery. Your medical team will evaluate your specific situation and advise you about your treatment options.

It is also important to remember that left atrial appendage amputation does not cure Afib. If you undergo LAA amputation, you will still need to work with your doctor to manage the symptoms of Afib. LAA amputation also does not totally eliminate the possibility of blood clots. LAA amputation is effective because it eliminates the possibility of blood collecting in the left atrial appendage, which is where most Afib-related blood clots form. Nevertheless, blood clots can still form elsewhere in the body and cause stroke or other problems.

Learn More

If you have Afib, you will want to talk with your medical team about strategies for reducing your stroke risk. You can learn more about Afib and how it relates to stroke in the SecondsCount Atrial Fibrillation Center.

If you are considering a left atrial appendage closure procedure, be sure to visit this website’s LAAC information center. You’ll find in-depth information on how the procedure works and who is eligible for it. Click here to get started.