At a glance
Left Atrial Appendage Closure (LAAC) is a heart procedure that permanently seals off a small pouch in the upper-left chamber of the heart, called the left atrial appendage, to prevent blood clots from escaping into the bloodstream.
In people with a heart rhythm disorder called atrial fibrillation (AF), the left atrial appendage does not squeeze properly, so blood can pool inside it and form clots. If a clot escapes, it can travel to the brain and cause a stroke. LAAC delivers a small plug or cap device through a thin tube (catheter) inserted into a vein in the groin, guiding it up to the heart and positioning it at the opening of the appendage so clots can no longer get out.
Medical Condition
LAAC is used mainly for people who have non-valvular atrial fibrillation (AF not caused by a damaged heart valve) and who need long-term protection against stroke but cannot safely take blood-thinning medicines for years.
- Non-valvular atrial fibrillation with a moderate-to-high stroke risk score, as judged by the cardiologist.
- Long-term use of blood thinners carries too high a bleeding risk, for example because of a history of serious bleeding in the stomach, intestines, or brain.
- Recurrent bleeding episodes that occur even while taking blood thinners.
- A lifestyle or occupation where taking daily blood thinners creates unacceptable risk, such as frequent falls.
- Intolerance or allergy to all available blood-thinning medicines.
- Previous stroke or transient ischaemic attack (a brief stroke-like episode) despite being on blood thinners.
LAAC is not suitable for everyone with AF. Doctors generally avoid it in certain situations.
- AF caused by a diseased heart valve (valvular AF), because the clot risk comes from the valve, not the appendage.
- A blood clot already present inside the left atrial appendage at the time of planning.
- Severe heart failure or a heart structure that makes catheter access unsafe.
- Active infection anywhere in the body.
- Allergy to the materials used in the closure device.
Risks & Complications
LAAC is generally well tolerated, but like any procedure that enters the heart, it carries recognised risks that your cardiologist will discuss with you beforehand.
- Pericardial effusion (fluid collecting around the heart): the most common serious complication, occasionally requiring drainage.
- Device embolisation: the closure device shifts from its position and travels inside the heart or blood vessels, requiring retrieval.
- Stroke or transient ischaemic attack during or shortly after the procedure, usually related to clot formation on the device in the early weeks.
- Air or clot embolism: small air bubbles or clots entering the bloodstream during catheter handling.
- Bleeding or bruising at the groin entry site, sometimes significant.
- Cardiac tamponade (blood pressing on the outside of the heart): a rare but serious complication that needs urgent treatment.
- Incomplete closure: a small gap remains around the device, which may need additional treatment.
- Anaesthesia-related reactions, including breathing difficulties during the procedure.
- Infection at the entry site or, very rarely, involving the device itself.
- Damage to surrounding structures, including the oesophagus (food pipe), which runs close to the heart.
Preparation & Procedure
Preparation begins days before the procedure. Your cardiologist will usually ask you to stop blood thinners on a schedule they set, because continuing them increases bleeding risk during catheter work. Alcohol should be avoided for at least 24 hours beforehand, and smoking stopped as early as possible, as both affect anaesthesia and healing.
You will stop eating solid food at least six hours before the procedure and stop drinking clear fluids usually two hours before, following the specific instructions given by your hospital. This is required because LAAC is performed under general anaesthesia (a medicine that puts you fully to sleep) or deep sedation.
Several tests are typically done in the days or weeks before the procedure to confirm you are a suitable candidate and to plan the device size.
- Transoesophageal echocardiogram (TOE/TEE): an ultrasound probe passed down the throat to get a close-up image of the heart and confirm there is no clot already in the appendage.
- Electrocardiogram (EKG): a recording of the heart's electrical activity to document the AF pattern.
- Blood tests: checking kidney function, liver function, clotting ability, and blood count.
- CT scan of the heart: used in many centres to measure the exact shape and size of the appendage so the right device is chosen.
- Chest X-ray: to check the lungs and overall heart size.
On the day of the procedure, the team follows a standard sequence of steps, though the exact order and duration can vary between hospitals and individual patients.
- 1. You change into a hospital gown and an intravenous (IV) line is placed in your arm for fluids and medicines.
- 2. Monitoring pads are attached to your chest for the EKG, and a blood-pressure cuff and oxygen sensor are fitted.
- 3. General anaesthesia or deep sedation is given, and a breathing tube or airway device is placed.
- 4. A TOE probe is inserted down the throat to guide the procedure in real time.
- 5. The cardiologist makes a small puncture in the groin and inserts a thin flexible tube (catheter) into a large vein.
- 6. The catheter is guided through the vein into the right side of the heart, then across the wall separating the two upper chambers (a step called transseptal puncture) into the left side.
- 7. Contrast dye is injected so the appendage is visible on X-ray, and measurements are confirmed.
- 8. The closure device is advanced through the catheter and positioned at the opening of the appendage.
- 9. The cardiologist checks the position using TOE and X-ray before releasing the device.
- 10. The catheter is removed, pressure is held on the groin to stop bleeding, and you are moved to a recovery area.
Aftercare
Most patients spend one to two nights in hospital after LAAC so the team can watch for early complications, particularly fluid around the heart. Recovery at home is usually measured in days rather than weeks for most people, but your cardiologist will set the timeline based on how the procedure went and your overall health.
- Monitoring: heart rhythm, blood pressure, and the groin puncture site are checked regularly in the hours after the procedure. An echocardiogram (heart ultrasound) is often done before discharge.
- Activity: most patients are advised to avoid heavy lifting, vigorous exercise, and driving for about a week, though your doctor will give you a specific plan.
- Groin care: keep the puncture site clean and dry. Watch for swelling, increasing pain, or signs of infection, and report them promptly.
- Blood thinners after the procedure: almost all patients take blood thinners or antiplatelet medicines (medicines that make platelets less sticky) for several weeks to months while the body's own tissue grows over the device. Your cardiologist decides the exact regimen and when to stop.
- Follow-up imaging: a TOE or CT scan is usually arranged at around 45 days after the procedure to confirm the device is in the right position and that tissue has sealed the appendage properly.
- Outpatient appointments: further check-ups are scheduled at intervals your cardiologist determines, typically over the first year.
- AF management: LAAC does not stop the AF itself, so medicines to control heart rate or rhythm may continue.
- Lifestyle: a heart-healthy diet, regular gentle activity as cleared by your doctor, not smoking, and limiting alcohol all support long-term recovery.
Cost & What Determines It
The cost of LAAC varies widely from one country and hospital to another, driven by the complexity of each patient's case, the type of closure device used, and the resources needed before, during, and after the procedure.
- Disease complexity: patients with additional heart conditions or unusual appendage shapes may need longer procedure times, more imaging, or a specialised device, all of which affect cost.
- Hospital class and country: a university-affiliated cardiac centre in one country may charge significantly more or less than a private hospital in another, even for identical devices.
- Type and size of closure device: different devices carry different prices, and the correct size must match the individual patient's anatomy.
- Length of hospital stay: an uncomplicated case may need only one overnight stay, while a complication can extend this to several days in a monitored ward or ICU.
- Anaesthesia and imaging fees: TOE guidance throughout the procedure and general anaesthesia are billed separately in many hospitals.
- Pre-procedure workup: CT scanning of the heart, TOE performed before admission, and multiple blood tests add to the overall bill.
- Post-procedure medicines: blood thinners or antiplatelet medicines taken for weeks to months after discharge are an ongoing out-of-pocket expense.
- Follow-up imaging: a TOE or CT scan at 45 days is standard practice and usually billed separately from the procedure itself.
Hospital packages, where offered, typically bundle the procedure room fee, the closure device, anaesthesia, and the standard hospital stay into one quoted price. What is usually billed separately includes pre-admission diagnostic tests, specialist consultation fees, medicines taken at home after discharge, and any follow-up imaging appointments.
BPJS Kesehatan and most Indonesian private health insurance policies do not cover medical treatment received abroad, so patients travelling overseas for LAAC almost always pay out of pocket or through an international private insurance plan that explicitly covers procedures done outside Indonesia. Before travelling, ask the hospital for a detailed written cost estimate covering every stage from admission to the 45-day follow-up scan. This written estimate is the most reliable way to understand the full financial commitment and avoid unexpected bills on arrival.
Frequently Asked Questions
How many sessions does Left Atrial Appendage Closure take?
Left Atrial Appendage Closure is a single procedure, not a course of sessions. The cardiologist guides a small plug-like device through a vein into the heart to seal off the left atrial appendage, a small pouch where blood clots can form, and this is done in one visit to the catheterization lab.
What does the procedure feel like, and will it hurt?
Most patients feel little to nothing during the procedure because it is performed under sedation or general anaesthesia, meaning you are deeply relaxed or fully asleep. Afterwards, some people notice mild soreness or bruising near the groin or wrist where the thin tube called a catheter was inserted, but this usually settles within a few days.
How soon will Left Atrial Appendage Closure start working, and what should I avoid during recovery?
The device begins blocking the appendage immediately after it is placed, but the heart tissue needs several weeks to grow over and fully seal around it. During this healing period, doctors typically advise patients to avoid heavy lifting, strenuous activity, and swimming until a follow-up check confirms the device is properly covered, and blood-thinning medication is usually continued for a period your cardiologist will specify.
How much does Left Atrial Appendage Closure cost?
The cost depends on several factors specific to this procedure, including the type and brand of the closure device used, the class of hospital or heart centre, the length of your stay for observation, and any additional tests needed before or after. Requesting a written estimate from your chosen hospital is the most reliable way to understand the full cost for your situation.
This page is general information, not a substitute for medical advice. Every case is different. Your doctor decides what is right for you.
