In case of sudden chest pain, shortness of breath or fainting, call 112.
Left atrial appendage (LAA) closure
The small pouch of the left atrium, where clots most often form in atrial fibrillation, is closed with a small plug placed by a catheter passed through the vein in the groin. It is considered for selected patients who cannot take blood thinners long term.
What is it?
Atrial fibrillation is a rhythm disorder in which the atria, the upper chambers of the heart, cannot contract normally. Blood then slows down in a small, pouch-like part of the left atrium (the left atrial appendage), and a clot can form there. If the clot breaks away and travels to the brain, it can cause a stroke. Blood-thinning medicines are the main way to prevent stroke. In some patients who cannot take these medicines long term, the opening of the pouch can be closed with a small plug placed by catheter. The aim is to reduce the risk of stroke by sealing off the area where clots most often form. Prof. Dr. Barış Kılıçaslan performs structural heart interventions, including left atrial appendage closure, in his clinical practice.
Who is it for?
- Patients with atrial fibrillation who are advised to take blood thinners because of their stroke risk
- Among them, selected patients who cannot take blood thinners long term, for example because of a previous serious bleed
- For patients who can take blood thinners without problems, medication is usually the first choice
- The decision is made by the heart team, weighing stroke and bleeding risks, general health and imaging findings together
Before the procedure
Before the procedure, the shape and size of the appendage are assessed. This is done with transoesophageal echocardiography (TOE), an ultrasound scan taken from inside the food pipe using a thin probe passed through the mouth, or with a CT scan. The scan also checks whether there is a clot inside the appendage, and the size of the plug is chosen from these measurements. Your medications, especially blood thinners, are reviewed with your doctor before the procedure. Do not stop any medication on your own. Because the procedure is usually done under general anaesthesia or deep sedation, you will be asked not to eat or drink for a period beforehand.
How is it done?
- Anaesthesia and imaging: General anaesthesia or deep sedation is usually used. Throughout the procedure the heart is watched with imaging such as TOE.
- Access: A thin sheath is placed in the vein in the groin and the catheter is advanced to the right atrium of the heart.
- Crossing between the atria: A small passage is made through the thin wall that separates the two atria, and the catheter is guided into the left atrium.
- Placing the plug: The folded plug is brought to the opening of the pouch and opened there to close it.
- Check and closure: The position and fit of the plug, and any leak around it, are checked with imaging. If all is well the plug is released from the catheter, the catheter is removed and the access site is closed.
Recovery
After the procedure you are closely monitored for a while. Short bed rest is advised to protect the access site in the groin. Before discharge, the position of the plug is checked with echocardiography. Over time, the heart's own tissue grows over the plug. During this period you take antithrombotic (anti-clotting) medicine for a while so that no clot forms on the plug. Your doctor decides which medicine and for how long. Follow-up scans (TOE or CT) check the position of the plug, any leak around it and whether there is a clot on it. After discharge, call 112 if you have growing swelling or bleeding at the access site, sudden breathlessness or chest pain, difficulty speaking, a drooping face, or sudden weakness in an arm or leg.
Risks
Like every interventional procedure, this procedure has risks. The main ones are bleeding or vessel injury at the access site, fluid collecting around the heart (which sometimes needs to be drained with a needle), stroke, the plug moving out of place and a clot forming on the plug. Any leak at the edge of the plug is also followed on the check-up scans. Your doctor will explain the possible benefits and risks for you in detail, based on your personal situation, before the procedure.
Frequently asked questions
- Will I be able to stop blood thinners completely after the procedure? The aim is to remove or reduce the need for long-term blood thinners. However, you will still take anti-clotting medicine for a while after the procedure, and some patients continue a milder medicine long term. Your doctor sets your plan based on the follow-up scans.
- Does the plug remove the risk of stroke completely? No. The aim is to reduce the risk of stroke by closing the area where clots most often form. Because stroke can have other causes too, control of risk factors such as blood pressure and diabetes continues.
- Does this procedure correct my irregular rhythm? No. This procedure does not treat atrial fibrillation. If you need medicines or other treatments for your heart rate or rhythm, these continue separately.
- Does the plug stay in my heart permanently? Yes, the plug is permanent. Over time, the heart's own tissue grows over it.
Medical content reviewed and approved by Prof. Dr. Barış Kılıçaslan. Last updated: 4 October 2026. Editor: Baran Zeydan (info@clinixcrm.app).