Stroke Risk Reduction

Blood clots that form in your heart — or move through your heart — can end up in the brain. A blood clot in the brain can occur due to a blood clot. The Structural Heart and Valve Disease team offers procedures that may decrease your risk of stroke, including:

Left Atrial Appendage (LAA) Occlusion Closure

Your heart’s electrical system sends signals to the heart muscles to make them contract and relax in a regular rhythm. The contracting and relaxing process moves blood from one chamber to next. If your heart rhythm is irregular (arrhythmia), your heart is less efficient and blood does not move easily from one chamber to the next.

When an arrhythmia occurs in the top chambers of the heart (the right and left atrium), it is called atrial fibrillation. If you have atrial fibrillation, your atria quiver (fibrillate), instead of beating regularly.

Symptoms of atrial fibrillation may include:

  • Pulse that feels rapid, racing, pounding, fluttering or too slow
  • Pulse that feels regular or irregular  (arrhythmia)
  • Sensation of feeling the heart beat (palpitations) 
  • Shortness of breath while lying down 
  • Confusion 
  • Dizziness, light-headedness 
  • Feeling faint (syncope) 
  • Fatigue

Individuals with coronary heart disease, heart failure, structural heart defects, rheumatic heart disease or pericarditis (inflammation of the tissue surrounding the heart) are more susceptible to atrial fibrillation.

Stroke Risk

Because atrial fibrillation causes the heart to quiver instead of beating forcefully and regularly, blood may get left behind in the atrium. When blood doesn’t move around, it can form blood clots. There is a risk that those blood clots will travel from the heart to the brain and cause a stroke.

Patients with atrial fibrillation are five times more likely to have a stroke than individuals who do not have atrial fibrillation. That is why many individuals with atrial fibrillation take blood thinners. These medicines have their own risks, including increased risk of uncontrolled internal or external bleeding, drug interactions and kidney and liver issues.

More than 90 percent of blood clots in patients with atrial fibrillation form in the left atrial appendage — a small, ear-shaped sac on the left atrium (the upper left chamber of the heart). In some cases, closing off the left atrial appendage can help prevent blood clots and may even reduce the need for blood thinners. This is especially beneficial to individuals who are not able to take blood thinners.

Closing the Left Atrial Appendage

The Structural Heart team at the Swedish Heart & Vascular Institute (SHVI) offers several options for left atrial appendage closure (also called left atrial appendage occlusion), including:

  • The WATCHMAN™ Device
  • LARIAT® Suture Delivery Device
  • AtriClip® Left Atrial Exclusion System

Your doctor will talk with you about these procedures. Together you will choose the procedure that is the best option for you.

The WATCHMAN Device: The U.S. Food and Drug Administration approved the WATCHMAN device as a permanent implant to plug the opening to the left atrial appendage. Once in place, it blocks blood from entering the sac. This device has been shown to be as good as blood thinners for preventing stroke in patients with atrial fibrillation. Your doctor will insert the device using a catheter inserted into a vein in your groin. The procedure takes about one hour. Patients typically spend one night in the hospital after the procedure. 


Watchman device:

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Watchman device positioned in the left atrial appendage.

LARIAT Suture Delivery Device: A cardiologist uses the LARIAT device in a catheter-based procedure (medical procedure that uses a catheter to deliver instruments and devices that are used to correct a medical condition) to implant a suture (thread-like material used to sew together edges of tissue) around the outside of the opening of the left atrial appendage. Like a cowboy’s rope lariat, the suture can be tightened. In this case, it closes off the opening to the left atrial appendage and stops the blood flow. The procedure takes about two hours. Patients typically spend one night in the hospital after the procedure.

AtriClip LAA Exclusion System: A heart surgeon uses a minimally invasive procedure to implant the AtriClip device on the outside of the opening to the left atrial appendage. This permanently clamps the opening closed and stops the flow of blood between the left atrium and the sac.  The procedure lasts about one hour. Patients typically spend one or two nights in the hospital after the procedure.

For more information about this procedure, go to Swedish Cardiac Surgery>

Patent Foramen Ovale (PFO) Closure

A human fetus naturally has a hole in the wall (septum) between the left atrium and the right atrium (the two upper chambers of the heart). This hole is called the patent foramen ovale or PFO. The PFO allows blood to circulate without going to the fetus’ lungs, which won’t begin working until birth. After birth, when the baby’s lungs are working, the hole typically closes because it is no longer needed.

About 25 percent of humans have a hole that didn’t close completely, which allows blood to leak from the right atrium to the left atrium, rather than going to the lungs first. Usually, this isn’t a problem and individuals can live normal lives with an unclosed PFO.

Sometimes, however, an open PFO can be a “side door” that allows very small blood clots, which the lungs normally filter out of the blood, to bypass the lungs and travel to the brain.

Closing the Patent Foramen Ovale (PFO)

Studies have shown that closing a PFO may be as good as drug therapy in limiting blood clots and reducing your risk of stroke.

The Structural Heart and Valve Disease team at the Swedish Heart & Vascular Institute (SHVI) and the Department of Neurology at the Swedish Neuroscience Institute (SNI) work together to offer a closure procedure for patients who have had a stroke with no known cause.

During this catheter-based procedure (medical procedure that uses a catheter to deliver instruments and devices that are used to correct a medical condition), you will be under conscious (twilight) sedation. Using a local anesthetic (special medicine to control pain), your cardiologist will make a small incision in your groin and then thread a catheter through a vein and up to your heart and the area where the hole is located. Your doctor will then use the catheter to deliver the closure device. Over time, your own tissue will grow over the device, making it permanent.

The closure procedure takes about one hour. Most patients remain overnight in the hospital after a PFO closure procedure.

If you have had a stroke with no known cause, take with your primary-care doctor, cardiologist or neurologist to see if you have an open PFO and whether closure of the PFO might be an option for you.

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Patent foramen ovale closure device.