Left Atrial Appendage Occlusion

Why am I having this procedure? 

You have a heart rhythm condition called atrial fibrillation (AF). In AF, the heart beats  irregularly and blood flow in part of the heart can become sluggish.

This increases the risk of blood clots forming, which can travel to the brain and cause a  stroke.

Most people with AF are treated with blood-thinning medications (such as warfarin or  direct oral anticoagulants). However, some patients:

• Have had bleeding complications
• Are at high risk of bleeding
• Cannot tolerate long-term blood thinners

The LAAO procedure is designed to reduce stroke risk without the need for lifelong blood thinning medication.

What is the left atrial appendage? 

The left atrial appendage (LAA) is a small pouch attached to the top left chamber of the  heart (the left atrium).  In patients with atrial fibrillation:

• Blood can pool in the LAA
• Over 90% of AF-related clots form in this area

Closing off the LAA reduces the risk of clot formation and stroke

What is the Watchman device? 

The Watchman device is a small, umbrella-shaped implant that permanently seals off the  left atrial appendage.

Once implanted:

• Blood can no longer enter the appendage
• The body gradually grows tissue over the device
• Stroke risk is reduced

The device stays in place permanently and does not usually need to be replaced.

How is the Watchman procedure performed?

Watchman procedure is a minimally invasive, catheter-based procedure.

• It is usually performed under general anaesthetic
• No open-heart surgery is required

A small incision is made in the vein at the top of the leg (the femoral vein). Using X-ray  and ultrasound guidance, catheters are guided up to the heart. A small puncture is made  between the upper chambers of the heart to reach the left atrium.

The Watchman device is then positioned and deployed to seal off the left atrial  appendage.

The procedure typically takes about 1 hour.

What happens when I come in for the procedure? 

• Admission and preparation
• You will be admitted to hospital on the afternoon before the procedure.
• Nurses will perform blood tests and an ECG.
• You will be given special skin cleansing products to reduce the risk of infection.
• An anaesthetist will meet you to explain the general anaesthetic.
• Dr Blusztein will meet you to answer any questions.

On the day of the procedure

• You will be taken to the cardiac catheterisation laboratory.
• After you are asleep, a specialised ultrasound probe (transoesophageal echocardiogram or TOE) is placed down the oesophagus to guide the procedure.
• The groin area will be cleaned with antiseptic and covered with sterile drapes.

Dr Blusztein will:

• Insert a catheter into the femoral vein in the groin
• Cross from the right side of the heart to the left atrium
• Position and deploy the Watchman device in the left atrial appendage

Once the device position is confirmed:

• The catheters are removed
• Internal stitches are used to close the vein
• You will be transferred to recovery and then back to the ward

Are there risks? 

Although the Watchman procedure is minimally invasive, it is still a heart procedure, and  all heart procedures carry some risk.

Possible but very infrequent risks include:

Bleeding or bruising at the groin

• Damage to blood vessels or heart structures
• Stroke or transient ischaemic attack
• Fluid around the heart (pericardial effusion)
• Heart rhythm disturbances
• Device movement or incomplete sealing
• Infection
• Kidney impairment from contrast dye
• Rarely, the need for emergency heart surgery or death

We would only recommend this procedure if the benefits outweigh the risks. Dr Blusztein  will discuss your individual risks with you in detail.

What happens after the procedure? 

• The usual hospital stay is 1 night.
• You will have an ultrasound of your heart to check the device position.
• Your groin site and heart rhythm will be monitored closely.

Medications after the procedure

You may need to continue blood-thinning medication for a short period after the  procedure while the device heals into place. This may include:

• A blood thinner for several weeks before repeat assessment. At that point, Dr  Blusztein will give you clear medication instructions tailored to your situation.

A follow-up appointment will be arranged, usually 45 days to 3 months after the  procedure, often including a TOE or CT scan to confirm complete sealing of the  appendage.

A letter will be sent to your GP and any other specialists involved in your care.

Should I stop any medications? 

This will be discussed when your procedure is booked. Please provide a current list of all  medications you are taking.

Please notify us if you take any of the following:

• Warfarin
• Apixaban
• Dabigatran
• Rivaroxaban
• Aspirin or clopidogrel
• Metformin
• Empagliflozin
• Dapagliflozin
• Insulin

Do not stop any medications unless you are specifically instructed to do so.

Do I need to fast? 

On the evening before the procedure, you may eat and drink as normal. You must then  fast from midnight.

On the morning of the procedure, you may take your usual medications (unless advised  otherwise) with a small sip of water.

Who should I contact if I have questions? 

If you have any questions or concerns, please contact us:

• Phone: (03) 9500 0296
• In person: Suite 17, Cabrini Hospital, Malvern
• Website: www.melbourneheart.com.au/contact/

If you experience worsening symptoms while waiting for your procedure, please let us  and your referring doctor know.