Percutaneous transcatheter closure of the left atrial appendage with endocardial implant, including fluoroscopy, transseptal puncture, catheter placement(s), left atrial angiography, left atrial appendage angiography, when performed, and radiological supe
CPT4 code
Name of the Procedure:
Percutaneous Transcatheter Closure of the Left Atrial Appendage with Endocardial Implant (LAA Closure)
Summary
This is a minimally invasive heart procedure aimed at closing off the left atrial appendage (LAA)—a small, ear-shaped sac in the heart—using a device inserted via a catheter. The procedure involves multiple steps, including fluoroscopy (real-time X-ray imaging), transseptal puncture (crossing from the right to the left atrium via a small hole in the heart's septum), and various angiographies (imaging studies).
Purpose
The procedure is designed to reduce the risk of stroke in patients with atrial fibrillation (AFib) by preventing blood clots from forming in the LAA and traveling to the brain.
Indications
- Patients with non-valvular atrial fibrillation who are at high risk for stroke and cannot tolerate long-term anticoagulation therapy.
- Documented history of AFib with prior stroke or transient ischemic attack (TIA).
Preparation
- Patients may need to fast for 6-8 hours before the procedure.
- Blood tests, echocardiography, and possibly a CT scan to assess heart structure.
- Adjustment or temporary discontinuation of certain medications, especially blood thinners.
Procedure Description
- Anesthesia: Typically performed under general anesthesia or conscious sedation.
- Access: A catheter is introduced via a vein in the groin and advanced to the heart.
- Transseptal Puncture: A needle puncture creates a small hole in the septum to access the left atrium.
- Fluoroscopy and Angiography: Real-time X-ray guidance helps in navigating the catheter and positioning.
- Catheter Placement: The catheter is maneuvered into the left atrial appendage.
- Device Deployment: The closure device is deployed to permanently seal the LAA.
- Verification: Imaging confirms the correct placement and effectiveness.
- Completion: The catheter is removed, and the puncture site is sealed.
Duration
Typically takes 1-2 hours to perform.
Setting
Usually performed in a hospital catheterization lab or specialized cardiac center.
Personnel
- Interventional cardiologist or cardiac electrophysiologist
- Anesthesiologist or nurse anesthetist
- Radiologic technologist
- Specialized nurses
Risks and Complications
- Bleeding or hematoma at the puncture site
- Pericardial effusion (fluid around the heart)
- Device-related complications, such as dislodgement or improper placement
- Risk of stroke during the procedure
- Infection
- Blood vessel damage
Benefits
- Significant reduction in stroke risk for patients unable to take anticoagulants
- Minimally invasive with a shorter recovery time compared to open-heart surgery
- Potential for improved quality of life and decreased need for long-term blood thinners
Recovery
- Short hospital stay, typically 24-48 hours
- Instructions on physical activity and medication adjustments
- Follow-up appointments for imaging and assessment
- Temporary use of anticoagulants until tissue overgrows the implanted device
Alternatives
- Long-term use of anticoagulant medications (e.g., warfarin, DOACs)
- Surgical left atrial appendage occlusion during open-heart surgery (e.g., maze procedure)
- Pros and cons vary, with the choice depending on patient-specific factors.
Patient Experience
- May experience mild discomfort or pressure at the catheter site.
- Post-procedure pain managed with medications such as acetaminophen or ibuprofen.
- Some fatigue or minor soreness, usually resolving within a few days.
- Support from the healthcare team to ensure comfort and address concerns.