Treatment: Closure of the left atrial appendage (Atrial appendage closure)

In this procedure, the left atrial appendage is closed using a small device inserted into the heart via the groin. Atrial fibrillation increases the risk of blood clots forming in the brain. The closure prevents clots of congealed blood from forming in the atrial appendage, thereby helping to prevent blood clots.

This treatment may be suitable for you if you suffer from atrial fibrillation but are unable to tolerate blood-thinning medication such as Eliquis, Xarelto, Pradaxa, Lixiana or Marevan, or have experienced serious bleeding complications. 

Closing the left atrial appendage may also be considered as an alternative to blood-thinning medication, even if you have experienced no side effects or bleeding complications.

Before your treatment, you will receive a letter via e-Boks informing you about fasting, medication, shaving and what to bring with you in connection with your treatment.

Although you are welcome to bring someone with you to the treatment, this is not necessary as you will be able to drive and use public transport, including flights, the day following the procedure. You are also welcome to bring a weekend bag or carry-on suitcase containing some spare clothes and toiletries.

On the day you are admitted, a nurse will meet you to help you settle in and provide information about your stay in hospital. You will be informed of the specific precautions that apply to your treatment. 

As procedure times vary, you should expect to wait, which in some cases may be up to several hours. However, you will be treated on the same day. 

Your blood pressure and pulse will be measured and an ECG will be taken. A plastic cannula will be inserted into a vein in your arm and a single dose of antibiotics will be given to prevent infection. 

The procedure is carried out under general anesthetic via the groin.

You will be put under general anesthetic and, once you are asleep, a local anesthetic will be administered to your groin. Catheters are guided through a vein into the right atrium of the heart and from there to the left atrium. The closure device is then guided through the catheter and its correct placement is confirmed using X-ray fluoroscopy and TEE (transesophageal echocardiography). 

The catheter will then be removed, after which the doctor will close the puncture site in your groin by applying pressure to the insertion site and placing a suture, which will be removed during your hospital stay.

The entire procedure takes approximately one and a half hours. 

After the procedure, you will be taken to your room on the ward. 

You must lie flat in bed for 2 hours. It is important that you do not lift your head, upper body or legs to prevent bleeding. A nurse will check the injection site, and your pulse and blood pressure will be monitored regularly.

Please inform the nurse if you experience any discomfort, pain, a sensation of warmth or swelling in the groin.

In a small number of patients, bleeding from the groin may occur after the procedure, which will mean that you will need to stay in bed for longer. The bleeding will usually result in an accumulation of blood in the groin area. This may cause pressure over the following days, particularly when walking, but it will usually resolve itself.

You may eat and drink immediately after the treatment.

Discharge

You will be discharged the following morning.

Before you leave, the insertion site will be checked and you will have an ultrasound scan of your heart. You will then have an opportunity to speak to the doctor in charge and discuss any precautions you may need to take in future. 

You will be given your discharge papers, and we will send a discharge letter and a description of your treatment to your GP and the hospital that referred you.

You are welcome to drive or take public transport (including flights) home on the day of discharge.

You will be given an appointment for a follow-up check-up six weeks after the treatment. A TEE scan will be performed at this appointment to ensure that the closure mechanism remains correctly positioned. You will be put under brief sedation for the examination, so you must fast beforehand and arrange for a relative to drive you home. 

You will then be discharged from Privathospitalet Mølholm.

Back home

The day after you are discharged, you can remove the plaster from your groin, provided the wound is dry.

Over the next few days, it is important that you do not overstretch or put strain on your groin. Therefore, we advise not playing sports, lifting anything heavier than 2 kg or cycling for the first four days following the procedure. You can certainly move around as normal. You can return to work after four days, depending on how physically demanding your job is.

Avoid hot baths, spas and seawater for 14 days.

For the first 12 months, you must take a single dose of preventive antibiotics in tablet form when visiting the dentist.

Complications from the procedure are rare (affecting less than 5% of patients overall) and include haematoma formation at the groin insertion site, cardiac tamponade (bleeding into the pericardium, with a risk of less than 1%) and closure device detachment (with a risk of less than 0.5%). These complications can be managed to prevent permanent damage.

If you experience severe breath shortness, chest pain or dizziness/fainting, call emergency services (112).

It is common to experience tenderness at the insertion site following the procedure.

If you notice any signs of infection in the groin area, such as redness, tenderness, pain or fever, please contact us or your GP.

In rare cases, bleeding may occur from the groin after discharge. Lie down on the floor and press firmly on the bleeding site with your hands; ask a relative to help you if possible. Contact us or another medical service.

Watch a video about atrial appendage closure here.