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Percutaneous left atrial appendage occlusion: impact on left atrial deformation indices

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Abstract

Background

Percutaneous left atrial appendage occlusion (LAAO) is an accepted alternative to thromboprophylaxis in patients with atrial fibrillation (AF) who are: (i) intolerant to oral anticoagulation (OAC) (e.g. life-threatening haemorrhage), (ii) non-adherent to OAC, or (iii) at a high bleeding risk with OAC. Improvement in LA mechanics was shown post-LAAO in the LAFIT-LARIAT study, using the Lariat device. No significant change was seen in LA mechanics after LAAO with the Watchman device in the LAFIT-Watchman study. The impact of LAAO with the Amplatzer or Amulet device on LA deformation mechanics has not been investigated.

Purpose

To evaluate the impact of LAAO with the Amplatzer or Amulet device on echocardiographic LA deformation indices.

Methods

All patients undergoing percutaneous LAAO from 2013 to 2021 at a single centre were included from an ongoing clinical registry. LA reservoir (εreservoir), conduit (εconduit) and contractile strain (εcontractile) and strain rate (SRreservoir, SRconduit, SRcontractile) were assessed with two-dimensional speckle tracking echocardiography from an apical four-chamber view. Conduit and contractile strain and strain rates were only recorded for patients without AF at the time of echocardiography. Changes in LA deformation indices over time were compared with a linear mixed model.

Results

28 LAAO recipients (mean age 73 ± 12 years, 68% male) were analysed. 5 (18%) patients had AF pre- or post-procedure. After a mean follow-up of 1.6 ± 1.4 months, the mean LA εreservoir increased from 10.15 ± 6.44% to 10.18 ± 8.72% (p = 0.985), the mean LA εconduit increased from 5.12 ± 5.48% to 5.31 ± 6.11% (p = 0.891) and the mean LA εcontractile decreased from 5.14 ± 4.32% to 4.95 ± 5.30% (p = 0.898). During the same time interval, the mean LA SRreservoir decreased from + 0.54 ± 0.23.s− 1 to + 0.48 ± 0.43.s− 1 (p = 0.566), the mean LA SRconduit remained stable: -0.47 ± 0.41.s− 1 to -0.47 ± 0.32.s− 1 (p = 0.997) and the mean LA SRcontractile decreased from − 0.66 ± 0.50.s− 1 to -0.55 ± 0.46.s− 1 (p = 0.660).

Conclusion

No significant improvement in LA mechanical function was seen after LAAO with the Amplatzer or Amulet device. Different LAAO devices therefore appear to have divergent effects on LA deformation, the clinical implications of which may warrant further study.

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Authors and Affiliations

  1. SAEndovascular, Kuils River Netcare Hospital, Kuils River, Cape Town, South Africa

    Andries P. Dippenaar, Jan A. Saaiman, Marshall J. Heradien, Paul A. Brink & Pieter van der Bijl

  2. Department of Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa

    Marshall J. Heradien & Paul A. Brink

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  1. Andries P. Dippenaar
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  2. Jan A. Saaiman
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Correspondence to Andries P. Dippenaar.

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MJH received financial support from Medtronic and is a Hamilton Naki scholar. The remaining authors have nothing to disclose.

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Dippenaar, A.P., Saaiman, J.A., Heradien, M.J. et al. Percutaneous left atrial appendage occlusion: impact on left atrial deformation indices. Int J Cardiovasc Imaging 39, 359–367 (2023). https://doi.org/10.1007/s10554-022-02741-6

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  • DOI: https://doi.org/10.1007/s10554-022-02741-6

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