The left atrial appendage is a small pocket protruding from the side of the left atrium, one of the upper chambers of the heart. It is left over from foetal development and seems to serve no purpose in a similar way to the appendix in the abdomen. In patients with certain heart rhythm disturbances (atrial fibrillation) blood clots can form in the atrial appendage. If the clot moves it can then cause stroke or other problems in the body.
Usually patients are treated with blood-thinning medication such as warfarin if they are at risk of clots in the atrial appendage. In some patients this is not possible due to bleeding risk. Another alternative is to close the left atrial appendage so clots cannot escape using specialised devices such as the Watchman device or the Amulet Amplatzer Cardiac Plug.
Closure can be performed as a keyhole technique under general anaesthesia. Patients usually spend 1 night in hospital. The device is inserted via a tube inserted into the vein near the top of the right leg.
The left atrial appendage is variable in size and shape between individuals. Screening is performed before closure with a trans-oesophageal echocardiogram and a cardiac CT scan.
Blood-thinning medication may be adjusted both before and after the procedure. A trans-oesophageal echocardiogram is performed 6 weeks after the procedure to ensure the device appears satisfactory.