Left atrial appendage
The left atrial appendage (LAA) is a small, ear-shaped sac in the muscle wall of the left atrium (top left chamber of the heart). It is unclear what function, if any, the LAA performs.
In normal hearts, the heart contracts with each heartbeat, and the blood in the left atrium and LAA is squeezed out of the left atrium into the left ventricle (bottom left chamber of the heart).
When a patient has atrial fibrillation, the electrical impulses that control the heartbeat do not travel in an orderly fashion through the heart. Instead, many impulses begin at the same time and spread through the atria. The fast and chaotic impulses do not give the atria time to contract and/or effectively squeeze blood into the ventricles. Because the LAA is a little pouch, blood collects there and can form clots in the LAA and atria. When blood clots are pumped out of the heart, they can cause a stroke. People with atrial fibrillation are 5 to 7 times more likely to have a stroke than the general population.
Taking a blood thinner, such as warfarin (Coumadin), reduces the risk of stroke in patients with atrial fibrillation. Many patients have concerns about, or dislike, taking warfarin. Some of the reasons for this are:
- Frequent blood draws are needed to measure the patient’s international normal ratio (INR), or clotting time. The tests are needed to make sure the patient takes the right amount of medication.
- While taking warfarin, you need to limit your intake of certain foods that contain vitamin K.
- The risk of bleeding is higher while taking warfarin.
- Some patients do not tolerate warfarin or have trouble maintaining a normal INR.
New medications are available for patients with atrial fibrillation who do not have heart valve disease. These medications are dabigatran (Pradaxa) and rivaroxaban (Xarelto). However, like warfarin, some patients have concerns and problems with these medications, such as:
- Patients who cannot take anticoagulants can not tolerate these medications.
- Some patients are concerned about the cost of the medication.
- These medications also increase the risk of bleeding.
Studies have shown that, among patients who do not have valve disease, the majority of blood clots that occur in the left atrium start in the LAA.
Closure of Left Atrial Appendage
If you are at risk of developing clots in the left atrium/LAA, your doctor may recommend a procedure to seal off your LAA. This can reduce your risk of stroke and eliminate the need to take blood-thinning medication.
There are several options and devices available for closure of the LAA. Your doctor will talk to you about the best options for your individual needs.
This information is about procedures and may include instructions specific to Cleveland Clinic. Please consult your physician for information pertaining to your specific procedure.