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Hemodynamic impact of percutaneous left atrial appendage closure in patients with paroxysmal atrial fibrillation

  • Lluis Asmarats
  • Mathieu Bernier
  • Gilles O’Hara
  • Jean-Michel Paradis
  • Kim O’Connor
  • Jonathan Beaudoin
  • Sylvie Bilodeau
  • Rafael Cavalcanti
  • Jean Champagne
  • Josep Rodés-Cabau
Article

Abstract

Purpose

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.

Methods

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.

Results

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).

Conclusions

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.

Keywords

Atrial fibrillation Percutaneous left atrial appendage closure Stroke volume Echocardiography 

Notes

Acknowledgments

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.

Ethical approval

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.

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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Lluis Asmarats
    • 1
  • Mathieu Bernier
    • 1
  • Gilles O’Hara
    • 1
  • Jean-Michel Paradis
    • 1
  • Kim O’Connor
    • 1
  • Jonathan Beaudoin
    • 1
  • Sylvie Bilodeau
    • 1
  • Rafael Cavalcanti
    • 1
  • Jean Champagne
    • 1
  • Josep Rodés-Cabau
    • 1
  1. 1.Quebec Heart & Lung InstituteLaval UniversityQuebec CityCanada

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