Hemodynamic impact of percutaneous left atrial appendage closure in patients with paroxysmal atrial fibrillation
- 204 Downloads
Percutaneous left atrial appendage (LAA) closure has become a valid alternative to anticoagulation therapy for the prevention of thromboembolic events in patients with atrial fibrillation (AF). However, scarce data exist on the impact of LAA closure on left atrial and ventricular function. We sought to assess the acute hemodynamic changes associated with percutaneous LAA closure in patients with paroxysmal AF.
The study population consisted of 31 patients (mean age 73 ± 10 years; 49% women) with paroxysmal AF who underwent successful percutaneous LAA closure. All patients were in sinus rhythm and underwent 2D transthoracic echocardiography at baseline and the day after the procedure. A subset of 14 patients underwent preprocedural cardiac computed tomography (CT) with 3D LA and LAA reconstruction.
Left ventricular systolic function parameters and LA volumetric indexes remained unchanged after the procedure. No significant changes in left ventricular stroke volume (72.4 ± 16.0 vs. 73.3 ± 15.7 mL, p = 0.55) or LA stroke volume (total 15.6 ± 4.2 vs. 14.6 ± 4.2 mL, p = 0.21; passive 9.0 ± 2.8 vs. 8.3 ± 2.6 mL, p = 0.31; active 10.3 ± 5.6 vs. 10.0 ± 6.4 mL, p = 0.72) occurred following LAA closure. Mean ratio of LAA to LA volume by 3D CT was 10.2 ± 2.3%. No correlation was found between LAA/LA ratio and changes in LA stroke volume (r = 0.35, p = 0.22) or left ventricular stroke volume (r = 0.28, p = 0.33).
The LAA accounts for about 10% of the total LA volume, but percutaneous LAA closure did not translate into any significant changes in LA and left ventricular function.
KeywordsAtrial fibrillation Percutaneous left atrial appendage closure Stroke volume Echocardiography
Dr. Asmarats is supported by a grant of the Fundación Alfonso Martin Escudero (Spain). Dr. Rodés-Cabau holds the Canadian Research Grant “Fondation Famille Jacques Larivière” for the Development of Structural Heart Interventions
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflicts of interest.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
- 5.Asmarats L, Rodés-Cabau J. Percutaneous left atrial appendage closure: current devices and clinical outcomes. Circ Cardiovasc Interv. 2017;10:e005359. https://doi.org/10.1161/CIRCINTERVENTIONS.117.005359.
- 7.Davis CA 3rd, Rembert JC, Greenfield JC Jr. Compliance of left atrium with and without left atrium appendage. Am J Phys. 1990;259:H1006–8.Google Scholar
- 18.Lang RM, Badano LP, Mor-Avi V, Afilalo J, Armstrong A, Ernande L, et al. Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. Eur Heart J Cardiovasc Imaging. 2015;16:233–71.CrossRefPubMedGoogle Scholar
- 19.Zoghbi WA, Enriquez-Sarano M, Foster E, Grayburn PA, Kraft CD, Levine RA, et al. American Society of Echocardiography. Recommendations for evaluation of the severity of native valvular regurgitation with two-dimensional and Doppler echocardiography. J Am Soc Echocardiogr. 2003;16:777–802.CrossRefPubMedGoogle Scholar
- 25.Budge LP, Shaffer KM, Moorman JR, Lake DE, Ferguson JD, Mangrum JM. Analysis of in vivo left atrial appendage morphology in patients with atrial fibrillation: a direct comparison of transesophageal echocardiography, planar cardiac CT, and segmented three-dimensional cardiac CT. J Interv Card Electrophysiol. 2008;23:87–93.CrossRefPubMedGoogle Scholar
- 26.Christiaens L, Varroud-Vial N, Ardilouze P, Ragot S, Mergy J, Bonnet B, et al. Real three-dimensional assessment of left atrial and left atrial appendage volumes by 64-slice spiral computed tomography in individuals with or without cardiovascular disease. Int J Cardiol. 2010;140:189–96.CrossRefPubMedGoogle Scholar