Thank you for choosing Rose Medical Center for your cardiac care. Our goal is to make your stay as comfortable and pleasant as possible. Please let our knowledgeable and friendly staff know if there is anything we can do to improve your experience.
What is left atrial appendage ligation?
The left atrial appendage (LAA) is a small, ear-shaped sac in the muscle wall of the left atrium. For patients with atrial fibrillation (A-Fib) the appendage is an area where blood clots can form and collect. When the heart pumps, it can send those the clots out of the heart and cause a stroke. The Lariat procedure allows your doctor to close and seal off this appendage. The Lariat is a device that looks like a lasso that loops around the appendage to close it off.
Why is this procedure being done?
Left atrial appendage ligation is a treatment option for people who:
- Have A-fib, which put them at risk for developing clots in the appendage
- Cannot tolerate blood-thinning medications
Before the Procedure:
You will be asked not to eat or drink anything after midnight the night before the procedure. Discuss your medications with your doctor, as he or she may want you to stop or adjust the doses several days prior to your procedure. Please bring all your current medications in their original bottles with you on the day of your procedure. Please bring a list of all drug/food allergies, past medical and surgical history also with you. We recommend that you wear comfortable clothing and bring a small bag with your personal items and toiletries in the event you spend the night in the hospital to make your stay as comfortable as possible.
What to Expect Upon Arrival to the Hospital:
When you arrive for your procedure, you will be asked to change into a gown. Please remove all undergarments and use the restroom as needed. Please let the staff know if you are taking blood thinners such as aspirin, warfarin, clopidogrel, prasurgel, ticagrelor, rivaroxaban, apixaban and dabigatran etexilate, diuretics (water pills), and/or any form of diabetic medication. An IV will be started so you can receive medications during your procedure and the nurse will review your medical history with you once again. At this time blood work will be drawn if needed and an EKG will be performed.
During the Procedure:
The temperature in our catheterization lab is kept cool to prevent damage to our x-ray equipment that is used during your procedure. We will offer you warmed blankets for your comfort. You will be assisted on to a special table for the procedure and then we will begin attaching monitoring equipment to you.
The cardiac cath lab staff will shave and cleanse your chest and groin while keeping your privacy as our primary concern. A sterile drape will be used to cover the groin and chest sites to prevent infection. You will be under general anesthesia during the entire case. There will be one small incision on your chest and small puncture site to your groin. The lariat procedure may take 4-6 hours. The more complicated cases can take more than 6 hours.
After the Procedure:
Following your procedure you will be moved to the recovery area, where your chest and groin area will be monitored. You will have sheaths (large IVs) in your groin and a small drain from the incision in your chest. Once it is safe, the nurse will remove the sheaths from your groin. The nurse will apply manual pressure on your groin to help the site close and heal. A sterile dressing will be placed on the groin site to protect you from infection and the site will be observed for signs of bleeding frequently by your nurse for the next several hours.
You will be on bedrest for the next 4 to 6 hours where you will be asked to lie flat, keep the affected leg straight, and not to sit up or lift your head to help reduce your risk of bleeding. Should you have increased pain, numbness or tingling to your toes and feet, and a warm sensation like you have wet the bed, please call your nurse immediately. The drain in your chest will be removed the following day by the doctor at the bedside.
- Bleeding at the site where the catheter was inserted
- Puncture of your heart
- Damage to your heart valves
- Stroke or Heart Attack
- Blood clots in the legs, lungs or brain
- Fluid around the heart (cardiac tamponade)
- Puncture of chambers within your heart
Contact Your Doctor If:
- Fever greater than 101 and/or chills
- Redness, swelling, tenderness, and pus-like drainage from the puncture site
- You have problems taking or obtaining any of your heart medications
Seek Care Immediately/Dial 911 If:
- Sharp Chest pain that becomes worse with deep breathing
- Increased shortness of breath
- Bleeding or swelling from your groin or chest site
- New and/or severe lower back pain (different from chronic back pain you may have)
- Coughing up blood
- Your leg below the puncture site changes color, becomes numb, or is cool to touch
- You have feelings of dizziness, extreme fatigue, or fainting spells
Follow Up and Discharge Instructions:
- Keep your groin and chest dressing clean and dry for 24 hours after the procedure. After 24 hours, you may remove the dressing and shower normally. DO NOT sit in a hot tub, whirlpool, swimming pool, or bathtub for 7 days.
- Refrain from using Band-Aids, powders, lotions or creams on the puncture/incision site.
- It is normal at the puncture/incision sites to have a small amount of bruising and some tenderness.
- Wear comfortable and loose-fitting clothes for the first 3 days following the procedure.
- Ask your doctor when it is safe to return to work and drive.
- Ask your doctor when it safe to resume sexual activity.
- DO NOT lift, push, or pull heavy objects (more than 10 pounds) for the first 7 days.
- If you need to cough, laugh, sneeze, or have a bowel movement, hold pressure on your groin site. DO NOT strain or bear down.
- Cleveland Clinic. (2015). Left Atrial Appendage and Closure . Retrieved from http://my.clevelandclinic.org/services/heart/services/left-atrial-appendage-closure.
If you have any further questions before your procedure please call the office and speak with your physician.
Thank You For Choosing Rose Medical Center For Your Cardiac Care!