Cardiac adnexal closure, an alternative to anticoagulants

An alternative intervention to the use of anticoagulants prescribed for atrial fibrillation is closure of the cardiac appendage. A non-invasive method, like catheterization, allows you to say goodbye to these drugs forever.

Patients with atrial fibrillation, the most common arrhythmia affecting more than a million people in Spain, may have several problems. The most alarming thing is that blood clots form in the atria of the heart, especially in the cavity called the appendage, as explained by EFEsalud. Rafael Ruiz Salmeron, interventional cardiologist at the University Hospital of Navarra.

Danger of blood clots

“Because blood pools there, it is more prone to form clots, clots that can migrate and cause a cerebral infarction, so people with atrial fibrillation are usually prescribed anticoagulants to prevent blood clotting,” says Ruiz Salmeron.

And this can happen because in this type of arrhythmia, the heart has a “chaotic” rhythm instead of a rhythmic and slow one. Thus, blood “begins to pool” inside this cavity, and the likelihood of a blood clot increases.

Cardiac appendageCardiac appendage
Cardiologist Rafael Ruiz Salmeron. Image courtesy of the University of Navarra Hospital.

According to the University of Navarra Clinic, the presence of atrial fibrillation, even temporary, increases the risk of stroke by five times.

Therefore, Ruiz Salmeron points out, a very strong argument is that if the problem is blood clots, the patient should be given an anticoagulant.

But you can act on the appendage yourself, closing it to prevent the blood clot from escaping and, therefore, avoiding a stroke without the need for lifelong use of anticoagulants.

Seal the appendage

The intervention, as stated by a cardiologist at the University Hospital of Navarra, is minimally invasive as it is carried out through catheterization. The patient is usually given a sedative or anesthetic, not because it is painful, but because a transesophageal ultrasound is usually also performed, which will act as an “eye” for doctors so they can get a good view of the inside of the heart.

During catheterization, after puncture of the femoral vein in the groin, access to the left atrium is through the right atrium and is carried out from right to left. The appendage is measured on site because “it is a structure so distinctive that it differs from person to person,” so no two are alike.

Intervention to close the appendage performed by Ruiz Salmeron. Images courtesy of the University of Navarra Hospital.

“We measure it, see what it feels like, and based on the dimensions it has, we select a device that can close it,” the doctor continues.

And there are devices of different sizes that can be inserted through the catheter, like a kind of plug that closes the appendage of the heart.

This is a device that can be inserted into a catheter at room temperature, but when the body temperature reaches 36 or 36.5 degrees, it expands and completely seals the appendage.

“Transesophageal ultrasound not only helps us see where we are, navigate and pinpoint where we are placing the device, but it also lets us know if we have properly sealed the appendage and if there is a lack of blood supply there,” Ruiz explains Salmeron.

Goodbye anticoagulants

The device does not need to be renewed, since after five to six months an endothelial coating forms, which makes it even difficult to visualize the installed plug with a camera.

“From the moment you know that the cardiac appendage has been occluded, you can stop taking the anticoagulant,” says the cardiologist.

The intervention usually lasts about an hour. The patient can go home the next day after discharge.


This intervention is primarily indicated for people with atrial fibrillation who cannot or should not take anticoagulants because they either have bleeding due to anticoagulants or are at high risk of bleeding due to certain clinical characteristics such as age (over 65 years of age) ), hypertension or kidney failure. or liver disease, among other things.

“But the truth is that if the patient is informed and knows about the risks of taking anticoagulants and what this intervention is, which is the approach we want to take at the University of Navarra Clinic, the patient can decide to close the appendage. the alternative is lifelong use of anticoagulants,” adds Ruiz Salmeron.

For this reason, “it is an alternative” to these drugs: “Patients are usually very clear about the fact that they have, so to speak, eliminated the stigma, especially the restriction of taking anticoagulants,” emphasizes the cardiologist from the University Hospital of Navarra. .

In fact, if we compare the evolution of patients receiving anticoagulants with those in whom the appendage was closed, it is seen that the first six months have more hemorrhagic effects.

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