Left Atrial Appendage Exclusion in New Jersey
For patients with atrial fibrillation (AFib) who cannot safely take long-term blood thinners, left atrial appendage (LAA) exclusion offers an effective alternative approach to stroke prevention. Cross County Cardiology evaluates and co-manages patients for this procedure in collaboration with leading electrophysiologists and structural heart programs throughout Northern New Jersey.
What Is the Left Atrial Appendage?
The left atrial appendage is a small, ear-shaped pouch in the wall of the left atrium — one of the upper chambers of the heart. In patients with atrial fibrillation, the chaotic electrical activity of the atrium prevents normal pumping, which can allow blood to pool and clot inside the LAA. An estimated 90–95% of strokes in patients with non-valvular AFib originate from clots that form in the LAA, break free, and travel to the brain.
Why Is LAA Exclusion Performed?
Anticoagulant medications (blood thinners) such as warfarin and direct oral anticoagulants (DOACs) significantly reduce stroke risk in AFib patients — but they are not suitable for everyone. Patients who may be candidates for LAA exclusion include those with:
- A high risk of bleeding that makes anticoagulation unsafe
- A history of serious bleeding on anticoagulant therapy
- Poorly controlled bleeding risk due to falls, prior hemorrhagic stroke, or other factors
- Patient preference to avoid lifelong anticoagulation after thorough discussion of alternatives
The goal of LAA exclusion is to eliminate the primary source of stroke-causing clots without the ongoing bleeding risk associated with anticoagulants.
The WATCHMAN Procedure
The most widely used catheter-based LAA closure device in the United States is the WATCHMAN (Boston Scientific). During this minimally invasive procedure:
- A catheter is guided through the femoral vein and across the wall separating the right and left atria (transseptal puncture)
- The WATCHMAN device — a small, plug-like implant — is advanced into the opening of the LAA and deployed to seal it off from the rest of the heart
- Over the following weeks, heart tissue grows over the device, permanently sealing the LAA
- Most patients are able to discontinue anticoagulation after approximately 45 days, once the device is fully endothelialized
The procedure is typically performed under general anesthesia and requires an overnight hospital stay. Most patients return to normal activities within a few days.
Surgical LAA Exclusion
For patients undergoing open-heart surgery for another reason (such as valve repair or coronary bypass), surgical LAA exclusion or ligation can be performed at the same time. This approach is recommended by current guidelines as an adjunct to cardiac surgery in AFib patients.
Is LAA Exclusion Right for You?
Not all AFib patients are candidates for this procedure. A thorough evaluation — including imaging with transesophageal echocardiography (TEE) to assess LAA anatomy and confirm no existing clot — is required. Our cardiologists will review your complete medical history, stroke risk score (CHA₂DS₂-VASc), bleeding risk, and anatomy to determine whether LAA exclusion is the most appropriate option for you.
Consult With Our Team in New Jersey
If you have atrial fibrillation and have had difficulties with anticoagulation therapy, contact Cross County Cardiology at (551) 373-9007 to discuss whether left atrial appendage exclusion may be right for you. We serve patients across Hudson and Bergen County from five convenient locations.
