Transcatheter left atrial appendage closure

The left atrial appendage is a small dead-end pouch attached to the left atrium. In atrial fibrillation, the atrium no longer contracts effectively and blood can stagnate in this pouch, where the vast majority of clots responsible for strokes form. The usual treatment to prevent these strokes is long-term anticoagulant medication. In some patients, this treatment is not possible or is dangerous, particularly after serious bleeding. Left atrial appendage closure then seals the entrance of the pouch with an umbrella- or plug-shaped wire-mesh device. It is brought through a vein at the groin and then into the left atrium across the interatrial septum (transseptal puncture). The procedure is guided by X-ray imaging and transoesophageal or intracardiac echocardiography, under general anaesthesia or sedation. The decision is made after careful assessment of the stroke risk and the bleeding risk, by cardiologists together, sometimes with the neurologist or gastroenterologist depending on the source of bleeding. Lighter antithrombotic treatment is still needed for a few weeks to a few months after implantation, until the device is covered by heart tissue. At Clinique Pasteur Tunis, this procedure is performed in a latest-generation catheterisation laboratory by an interventional cardiology team, supported by echocardiography and with a cardiac surgery team on site.