Risks

Although there are several different left atrial appendage occlusion (LAAO) methods to treat atrial fibrillation (Afib), it’s important to remember that none of them actually cure Afib. If you undergo LAAO, you’ll still need to work with your doctor to manage the symptoms of Afib. LAAO procedures also don’t totally eliminate the possibility of blood clots. LAAO procedures are effective because they eliminate the possibility of blood collecting in the left atrial appendage (LAA), where most Afib-related blood clots form. Nevertheless, blood clots can still form elsewhere in the body and cause a stroke or other problems.

It's also important to understand that all procedures include the risk of complications. This means that a problem could develop during or after the procedure. If you’re considering a LAAO procedure (or any procedure or surgery), you’ll 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.

Surgical LAA closure or removal

One method for closing off the LAA is 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 enter or exit the LAA. There are two types of LAA ligation: pericardial ligation, a minimally invasive procedure where the heart is accessed through tiny tubes called catheters, and surgical ligation, performed during open-heart surgery where your surgeon stitches the LAA closed.

Risks of a pericardial ligation LAAC

At the beginning of the procedure, a transesophageal echocardiogram (TEE) will be performed to ensure there's no blood clot in the heart. However, it’s possible that during the procedure, a blood clot or air embolus could form in the catheter and be injected into the heart. If this travels to the brain, it could cause a stroke. Your doctor will be aware of this risk and will take steps to minimize this risk.
It’s possible that the LAA could rupture while the device is deployed, which would require emergency heart surgery to repair.
There’s a risk of infection at the two access sites where catheters are inserted into the blood vessels that lead to the heart.
Many people will require treatment for pericarditis, an inflammation of the pericardial sac surrounding the heart.
Most people are advised to continue taking aspirin after the procedure.

Risks of a surgical ligation LAAC

As with all surgical procedures, there is a risk of infection.
Most people will likely need to continue taking aspirin.
Recovery from open-heart surgery takes time, often weeks. (Cardiac rehabilitation is recommended for most people because it supports recovery and promotes heart-healthy habits.)

LAA clamping

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

Risks of an LAA amputation

There’s a risk of infection.
Most people will likely need to continue taking aspirin.
Recovery from open-heart surgery takes time, often weeks

Occlusion

Another LAAC method is called occlusion. This technique involves implanting a small device in the opening of the LAA sac, preventing blood from flowing 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 and the AMPLATZER Cardiac Plug. The U.S. Food and Drug Administration (FDA)-approved WATCHMAN device1 is delivered to the heart through a blood vessel, which means that open-heart surgery is not required. The AMPLATZER Cardiac Plug2 is also delivered through a blood vessel to the heart, where it’s 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 LAA as well, although this device isn’t yet approved by the FDA for this purpose.

Risks of LAAO

It’s possible that the LAA could rupture while the device is deployed, which would require emergency heart surgery to repair.
There’s a risk of infection at the access site where the catheter was inserted into the blood vessel that leads to the heart.
Most people probably will have to continue taking aspirin.
There’s a risk of infection at the access site where the catheter was inserted into the blood vessel that leads to the heart.
Most people will likely need to continue taking aspirin.

Left Atrial Appendage Occlusion (LAAO)