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This handout explains what a left atrial appendage is, why it may need to be closed, and how that is done.
Left Atrial Appendage (LAA)
The LAA is a small area in the left atrium of your heart. It does not serve a purpose so it is not needed.
When a person has atrial fibrillation (a-fib), the top part of their heart does not beat in a regular pattern. Because of how the LAA is shaped, blood can pool in it and form clots. It is believed that most of the clots formed in the heart come from the LAA. These clots can move up to the brain and cause a stroke.
During this procedure, a device called a Watchman is placed in the LAA. This will close off the LAA so clots do not form. While many people take blood thinners to decrease their chance of forming a clot, some people can’t take these medicines long-term. Having a Watchman device may be an option for people taking long-term blood thinners.
To be considered for the Watchman device, there are criteria that you must meet:
A-Fib that is not due to a heart valve problem
Can’t tolerate long-term blood thinners due to:
History of serious bleeding while taking them
Job, condition, or hobbies that increase your bleeding risk
Not able to take your blood thinners correctly
High risk for falls
Can take blood thinners short-term
Can undergo the procedure
Can complete follow-up visits
You don’t meet the criteria if:
You are allergic to nickel or titanium
Your LAA is too small or too large and the device would not fit
You take blood thinners for reasons other than a-fib
You can’t meet any of the criteria.
Before the Procedure
If you meet criteria, we will schedule you to meet one of the doctors. At that visit you will talk about the Watchman device and procedure to decide if it is the best option for you. You will have the chance to get all your questions answered. You may also need to have a special image of your heart done to be sure the right size device is used.
The Watchman procedure is covered by all major insurance companies including Medicare for patients that qualify. Your coordinator may be able to help you with any insurance issues.
The Day of Procedure
On the day of your procedure, you will go to the Cardiac Cath Lab (F6/3). Once there you will meet your nurse, doctor and other staff who will answer your questions and make sure you are comfortable.
During the Procedure
We will watch you closely during the procedure. The process is outlined below.
You will have patches placed on your chest to monitor your heart. You will also have a plastic clip on your finger so we can watch your oxygen levels.
You will have a small tube (IV) in your vein to give medicine.
You will have a small tube in your vein to check your blood pressure.
You will get medicine to make you sleep during the procedure.
A breathing tube will be placed, along with a camera to guide the procedure.
A small poke is made in a large vein in your groin and a catheter (thin tube) is placed all the way up to the heart.
The catheter passes from the right side of the heart to the left side. This assures the correct position for the Watchman device.
Once in place, the tube is removed and the Watchman device is left in.
After the Procedure
You will spend the night in the hospital. We will watch you closely and help control your pain. Before you leave, you will learn how to care for yourself at home.
A family member or friend must drive you home. It would be helpful for that person to stay with you for the first day or two. They should be present the day you go home so they can hear the discharge instructions.
You will get prescriptions for medicines. If you plan to fill them at the hospital pharmacy, please bring your insurance card with you.
Your follow-up care includes:
You will need an image of your heart taken in 45 days.
You will have a separate clinic visit with the doctor that placed the device.
You will need lab draws after 6 months, 1 year, and 2 years. These can be done at your local clinic if you do not live in Madison. A nurse will call you about the lab draws.
If you are a patient receiving care at UnityPoint – Meriter, Swedish American or a health system outside of UW Health, please use the phone numbers provided in your discharge instructions for any questions or concerns.