Percutaneous Left Atrial Appendage Closure
WATCHMAN
Percutaneous Left Atrial Appendage Closure
Percutaneous Left Atrial Appendage Closure
Provided by Boston Scientific Japan Co., Ltd.
What is Percutaneous Left Atrial Appendage Closure?
– Have you been diagnosed with atrial fibrillation and are taking blood-thinning medication? –
Atrial fibrillation is a type of arrhythmia. Catheter ablation is the treatment for atrial fibrillation itself (please refer to ‘Arrhythmia’). Atrial fibrillation can cause stroke, and those with certain risks are recommended to take antithrombotic drugs to prevent stroke. However, long-term use of antithrombotic drugs can cause bleeding. Percutaneous left atrial appendage closure is a stroke prevention treatment for those who have experienced bleeding problems or are at high risk of bleeding.
The reason why atrial fibrillation increases the risk of stroke is that blood clots form in the left atrial appendage, located in the upper left part of the heart, and these clots can travel through the bloodstream to organs throughout the body, including the brain. The left atrial appendage is shaped like a pouch, and percutaneous left atrial appendage closure prevents clot formation by sealing it off with an occluder. This treatment uses a catheter and is performed under general anesthesia, but the incision is small, and patients can walk the day after the procedure.
Percutaneous left atrial appendage closure is a preventive treatment possible for both those who have and have not had a stroke (suitable for both primary and secondary prevention).
Process of Percutaneous Left Atrial Appendage Closure
To understand the shape and size of the left atrial appendage, a transesophageal echocardiogram (a heart ultrasound similar to a gastroscopy) and cardiac CT are performed in the outpatient clinic. The patient is admitted the day before the procedure for IV preparations. On the day of the catheter treatment, under general anesthesia, a sheath (plastic tube) is inserted into the vein in the groin to allow the catheter to be inserted and removed. A needle is advanced through this tube to the atrial septum, which separates the right and left atria, and a hole is made in the atrial septum to insert a guidewire. A guide catheter about 5mm in diameter is inserted along the guidewire from the left atrium into the left atrial appendage. The occluder is transported through the guide catheter to the left atrial appendage, placed to fit, and closes the left atrial appendage. The catheter is then removed, and the treatment is complete. Patients can walk from the next day. After confirming the post-operative condition, discharge is on the second day after surgery (typical hospital stay: 3 nights and 4 days).
Benefits of Percutaneous Left Atrial Appendage Closure
If the left atrial appendage is successfully closed through percutaneous left atrial appendage closure, antithrombotic medication can be reduced after about 2-6 months post-treatment. Specifically, the ‘anticoagulant’ often used for stroke prevention in atrial fibrillation can be changed to an ‘antiplatelet drug’. While antiplatelet drugs themselves are not highly effective in preventing stroke in patients with atrial fibrillation, they reduce the risk of cerebral hemorrhage. For those who have undergone percutaneous left atrial appendage closure, taking antiplatelet drugs is expected to provide almost the same stroke prevention effect (including both ischemic stroke and cerebral hemorrhage) as anticoagulants. It is also said that by reducing cerebral hemorrhage, it can decrease the occurrence of strokes with significant aftereffects.
Who is Percutaneous Left Atrial Appendage Closure Effective For? (Indications)
This procedure is for those with ‘atrial fibrillation’ who need to take antithrombotic drugs for stroke prevention. Among these, it is indicated for those who have a high risk of bleeding when taking antithrombotic drugs or those who have actually experienced troublesome bleeding. While the suitability for individual patients is determined by the doctor, patients with atrial fibrillation who think, ‘I’m taking blood thinners, but I’m scared of bleeding again because I’ve bled before,’ are likely to be good candidates.
Strengths of St. Luke's International Hospital
Interdepartmental Collaboration
We hold Brain Heart Conferences with neurologists including stroke specialists. As this treatment is for stroke prevention, and it’s necessary to consider the cause and risks of stroke when determining the treatment plan, we have a system that easily reflects expert opinions from the neurology field. Also, as we target patients with high surgical risks, management of comorbidities is essential. Our hospital has many departments and values interdepartmental collaboration, allowing patients to receive specialized support for conditions other than heart diseases with peace of mind.
Safe, Secure, and Comfortable Recovery Environment with All Private Rooms
If the postoperative course is favorable, patients are transferred to the general ward the day after surgery. All our general wards are private rooms, allowing for a quiet and relaxed hospital stay. Not only is your privacy protected, but we also provide a safe and secure environment that can reduce the risk of infection from other patients.
