Version July 2025
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What is the left atrial appendage? —
The left atrial appendage, or "LAA," is a small hollow pouch off the left atrium (figure 1). This is the upper left chamber of the heart.
The pouch expands and fills with blood when the pressure in the left atrium is higher than normal. When a person has atrial fibrillation, or "A-fib," blood clots can form in the LAA. This can be dangerous, because a blood clot can travel to the brain and cause a stroke.
What is an LAA closure? —
This is a way to block off the small pouch and prevent blood clots from leaving it and entering the blood stream (figure 2). The procedure does not make A-fib or other heart problems go away. But it can lower the chance of a blood clot leaving the LAA and causing a stroke.
How do I prepare for an LAA closure? —
Your doctor will ask you about your "health history." This involves asking you questions about any health problems, past surgeries, and any medicines you take. Tell them about:
●Any medicines you are taking – This includes any prescription or "over-the-counter" medicines you use, plus any herbal supplements you take. It helps to write down and bring a list of any medicines you take, or bring a bag with all your medicines with you.
●Any allergies you have
●Any bleeding problems you have – Certain medicines, including some herbs and supplements, can increase the risk of bleeding. Some health conditions also increase this risk.
The doctor or nurse will tell you if you need to do anything special to prepare. Before surgery, your doctor will do an exam. They might send you to get tests, such as:
●Transesophageal echocardiogram, or "TEE" – This uses sound waves to create images of the heart. The TEE tube is passed through the mouth and down the throat to get a close view of the LAA.
●Cardiac MRI or cardiac CT scan – These are imaging tests that create images of the heart and nearby parts.
You will also get information about:
●Medicines – You might need to take or stop certain medicines before the procedure.
●Eating and drinking – You might need to "fast" before the procedure. This means not eating or drinking anything for a period of time. Or you might be allowed to have liquids until a short time before the procedure. Whether you need to fast, and for how long, depends on the procedure.
●Lowering the risk of infection – You might need to trim (not shave) your body hair before the procedure. You might also need to wash the area with a special soap.
●What help you will need when you go home – For example, you might need to have someone else bring you home or stay with you for some time while you recover.
Ask the doctor or nurse if you have questions or if there is anything you do not understand.
What happens during an LAA closure? —
When it is time for the procedure:
●You will get an "IV," which is a thin tube that goes into a vein. This can be used to give you fluids and medicines.
●You will get anesthesia medicines. This is to make sure you do not feel pain during the procedure. Types of anesthesia include:
•Conscious sedation – This is used for most percutaneous procedures. It uses medicines called "sedatives" to make you relax and feel sleepy. You might also receive local anesthesia medicine to numb a small part of your upper leg (or arm) so you don't feel pain.
•General anesthesia – This is used for surgical closures. It makes you unconscious so you can't feel, see, or hear anything during the procedure. You will get a breathing tube to help you breathe.
●The doctors and nurses will monitor your breathing, blood pressure, and heart rate during the procedure.
●An LAA can be closed in 2 main ways (figure 2):
•A procedure through the skin – The doctor makes a small cut (incision) in the skin of your upper leg or in your arm. They pass a thin plastic tube called a "catheter" through the incision and into a blood vessel. Then, they make a small hole in the tissue between your right and left atrium. This lets the catheter get close to your LAA. They pass a small closure device through the catheter to your heart. The small device is used to block or plug the pouch.
•Heart surgery – If you are having heart surgery for another reason, the doctor might close your LAA during that. During heart surgery, the doctor opens your chest to see your heart. Then, they can close the LAA with:
-A band or loop
-A clip
-Stitches (called "sutures")
●The doctor will close the incision and cover it with a clean bandage.
What happens after an LAA closure? —
You will be taken to a recovery room. The staff will watch you closely as your anesthesia wears off. If your LAA was closed with a percutaneous procedure, you will likely spend the night in the hospital. If it was closed during surgery, you stay in the hospital longer.
As you recover:
●You might feel groggy or confused for a short time. You might also feel nauseous or vomit. The doctor or nurse can give you medicine to help with this.
●If you had a breathing tube, you might have a sore throat. This usually gets better quickly.
●The staff will help you get out of bed and start moving around when you are ready.
●You will get medicine to help with pain if needed. You might need other medicines, too.
●When you are ready to eat, you will start with clear liquids. Then, you can start eating as you are able. You might feel better if you start with bland foods.
●You might be able to return to normal activities sooner after an LAA closure procedure through the skin than after heart surgery.
What are the risks of LAA closure? —
Your doctor will talk to you about all the possible risks, and answer your questions. Possible risks include:
●Bleeding or blood clots
●The LAA not getting fully closed, and blood clots continue forming
●The closure device moving out of place
●The closure device puncturing the atrial wall, and blood leaking out of the heart
●Stroke
●Infection
●Death (rare)
Do I need to take an anticoagulant? —
After your LAA is closed, you need to take an anticoagulant medicine to prevent blood clots for weeks. After that, you might be able to stop or change the medicine.
What else should I know? —
Before you go home from the hospital, make sure you know what problems to look out for and when to call the doctor. Make sure you understand your doctor's or nurse's instructions. Ask questions about anything you do not understand.
Patient education: Left atrial appendage closure – Discharge instructions (The Basics)
Patient education: Atrial fibrillation (The Basics)
Patient education: Anticoagulant medicines – Uses and kinds (The Basics)
Patient education: How to take anticoagulants safely (The Basics)
