Why are you being offered a closure of the atrium?

This technique consists of implanting a prosthesis in the left atrium of the heart to prevent blood clots from forming and possibly causing a stroke.

It is a validated alternative in patients at risk of clot formation and with a contraindication to oral anticoagulation. Atrial fibrillation (AF) is a heart condition that causes the atria to contract uncontrollably. This abnormality causes blood to stagnate and clot to form in the heart, mainly in the left atrium.

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The left atrium is a small sac at the level of the left atrium, at the top of the heart. If a clot forms, there is a risk of a stroke. AF is responsible for nearly 20% of ischemic strokes. Oral anticoagulant therapy in patients at high risk of thromboembolism aims to prevent clot formation, but may have adverse effects, including significant bleeding. In the event of contraindication or poor tolerance of anticoagulant treatment, the atrial closure device can therefore prevent the formation of clots. This is an implant made of materials found in many medical devices, which aim to close the auricle.

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Performing the closure of the atrium:

During this procedure: It is necessary to be fasting, lying on an X-ray examination table located in a specially equipped room. General anesthesia is very often performed, the procedure lasting about 1 hour.

A right femoral vein puncture is performed, a probe is inserted into the right and then the left atrium, allowing the left atrium to be measured by taking images of the heart, and thus to ensure that the device is in the right position.

Once this is done, the device is released to leave it permanently implanted in the heart.

However, this procedure requires guidance by transesophageal ultrasound.

​In order to avoid local bleeding after the procedure, compression is performed at the puncture points.

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2 types of devices can be used:

− Boston Scientific device: Watchman

− Abbott device: AMPLATZER/AMULET

 

After this procedure: The healing period is about 45 days during which it is necessary to continue taking anticoagulants or antiplatelet agents as prescribed. You may also be prescribed an antibiotic to prevent an infection from occurring later on.

 

What are the risks associated with the installation of the auricle closure device?

​1. Among the complications identified by the surveys carried out in many French, European and North American centres, most are benign:

− hematoma at the puncture site,

− Transient chest pain.

2. Some are more serious and may require surgery:

a. Risks associated with the practice of a puncture in general: hematoma, false aneurysm, atrioventricular fistula

b. Risks more specific to the implementation of the device: Potentially serious complications generally occur during the procedure or in the first week:

− Pericardial effusions are the most frequent and serious complications, with a rate of tamponades (cardiac compression) that can require drainage of up to 1 to 2%.

− The risk of stroke is 1 to 2%.

− The risks of prosthesis migration are very rare, < 1%.

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All precautions are taken before, during and after the operation to limit these risks as much as possible.

 

What benefits can be expected from the auricle closure device?

​Closing the atrium atrial avoids anticoagulant treatment and reduces the risk of long-term strokes. Percutaneous closure of the left atrial is not a "comfort" or "fashionable" treatment

 

of life", in order to spare the patient from oral anticoagulation. Percutaneous closure of the left atrium is not a treatment for atrial fibrillation itself and heart rate control measures may be

possibly prove to be necessary in addition.