Percutaneous left atrial appendage (LAA) closure is increasingly used to prevent strokes in patients with atrial fibrillation (AF). The alteration of left atrial (LA) compliance by LAA occlusion may represent a clinical issue in AF patients, which are also at high risk of heart failure (HF).
To describe the impact of LAA occlusion on LA hemodynamics.
Materiel and methods
This study included patients who underwent LAA occlusion procedure in whom LA pressure curves were recorded, before and immediately after device implantation. Mean LA pressure was defined as abnormal when >15mmHg. We recorded all cause death and hospitalizations for congestive HF at longest follow-up.
We enrolled 86 patients (78±8 years, 46 men). The mean LA pressure increased significatively after LAA closure from 12.6±3.9mmHg to 15.6±5.2mmHg (P<0.0001, Fig. 1). The prevalence of abnormal mean LA pressure was 20% at baseline and 45% after LAA closure (P=0.006). Post procedural LA pressure elevation was not related to procedure duration nor to fluid expansion volume. After an average follow-up of 363 [120–731] days, 9 (10%) patients died and 6 (7%) were hospitalized for HF. There were more events (N=11 of 39, 28%) in patients with abnormal post procedural LA pressure as compared to the rest of the population (N=4 of 47, 9%; P=0.02). All HF hospitalizations occurred in patients with abnormal post procedural LA pressure (P=0.0007).
Catheter-based LAA occlusion induces an acute alteration of LA hemodynamics that seems to be linked to HF episodes. Further studies are warranted to investigate HF as a potential late complication of LAA closure.Le texte complet de cet article est disponible en PDF.