Impact of left atrial appendage occlusion on left atrial function—The LAFIT Watchman study

Murtaza, Ghulam; Vuddanda, Venkat; Akella, Krishna; Rocca, Domenico G. Della; Sharma, Sharan Prakash; Li, Ling; Kutty, Shelby; Turagam, Mohit K.; Kar, Saibal; Holmes, David R.; Lakkireddy, Dhanunjaya

doi:10.1007/s10840-019-00674-0

Cited by 18 publications

(21 citation statements)

References 15 publications

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“…To date, the role of LAAC in LA function has been controversial. Previous studies have demonstrated that percutaneous LAAC did not translate into any significant changes in LA function as assessed by LA volume and strain indices (19,20). The same results were also reported in patients with surgical LA appendage exclusion (21), which is consistent with our findings.…”

Section: Discussionsupporting

confidence: 93%

Effect of Left Atrial Appendage Closure in Combination With Catheter Ablation on Left Atrial Function for Persistent Atrial Fibrillation

Yang

Liu

Feng

et al. 2021

Front. Cardiovasc. Med.

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Background: A single procedure combining left atrial appendage closure (LAAC) plus catheter ablation (CA) has been proven to be safe and feasible for treating atrial fibrillation (AF). However, the influence of treatment modality on left atrial (LA) function is not thoroughly explained.Objective: We aimed to investigate the changes of LA function in persistent AF patients undergoing concomitant LAAC and CA.Methods: The study population comprised 65 patients who underwent combined AF ablation and Watchman LAAC (combined therapy group) in our center, and 65 participants of the AF simple ablation group who were matched based on sex, age, CHA2DS2-VASc score and HAS-BLED score using propensity score matching. During the 1-year follow-up period, two-dimensional echocardiography and speckle tracking echocardiography were performed to assess LA reservoir, conduit, and contractile function.Results: The combined therapy was associated with a significant improvement in the LA reservoir function with increased expansion index and strain indices, including strain and strain rate (SR) during ventricular systole. Conduit function with SR during early ventricular diastole was also improved, as was contractile function with active atrial emptying fraction and SR during atrial systole. Similarly, LA reservoir and contractile function indices all improved continuously during follow-up after catheter ablation alone. At 3 months follow-up LA reservoir and conduit function with strain indices had a tendency to improve only in the simple procedure group. At 1-year follow-up there was no significant difference in either LA volumes or strain indices between the two groups.Conclusion: Both the combined therapy group and the simple ablation group demonstrated significant improvement in LA function. Based upon the fact that LA function was improved in both groups it might be concluded that most of the effects appeared to result from ablation, not LAAC; furthermore the additional LAAC procedure did not affect the improvement of LA function after CA.

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Section: Discussionsupporting

confidence: 93%

Effect of Left Atrial Appendage Closure in Combination With Catheter Ablation on Left Atrial Function for Persistent Atrial Fibrillation

Yang

Liu

Feng

et al. 2021

Front. Cardiovasc. Med.

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“…The LAA is a hormone-producing organ with contractile function, and the effects of LAAC on cardiac function remain controversial. Previous studies have demonstrated that percutaneous LAAC did not translate into any significant changes in LA function assessed by LA volume and strain indices [ 22 , 23 ]. De Maat et al [ 24 ] also reported the same results in patients with surgical LAA exclusion.…”

Section: Discussionmentioning

confidence: 99%

Impact of Left Atrial Appendage Closure Combined with Catheter Ablation on Endocrine and Mechanical Cardiac Function in Patients with Atrial Fibrillation

Yang

You

Liu³

et al. 2022

Journal of Interventional Cardiology

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Background. The combined procedure of left atrial appendage closure (LAAC) and catheter ablation (CA) is a safe and feasible therapy to treat patients with atrial fibrillation (AF). However, the effect of the combined procedure on cardiac function remains unclear. This study aimed to investigate the changes in endocrine and mechanical function of the heart following the combined procedure. Methods. This retrospective study included 62 consecutive patients who underwent the combined procedure of AF ablation and WATCHMAN LAAC and 62 sex and age-matched patients who only received AF ablation. During follow-up, patients were examined for brain natriuretic peptide (BNP) levels to represent endocrine cardiac function. Mechanical cardiac function was assessed during echocardiographic examination by means of the LA ejection fraction, LA strain (Ƹ), and LA strain rate (SR). Results. (1) The BNP levels decreased acutely after the procedure, rose at day 3 postoperation, but trended downwards at 3 months postoperation in both groups. No significant difference was observed between the two groups. (2) LA ejection fraction, LA Ƹ, and SR exhibited a continuous upward trend over a 3-month follow-up in both groups. There was no significant difference in LA ejection fractions, SRe (the parameter of LA conduit function), and SRa (the parameter of LA booster pump function) between the two groups. However, the Ƹ and SRs (the parameters of LA reservoir function) improved in patients treated with CA alone. Conclusions. The combined procedure of LAAC and CA significantly improved the endocrine and mechanical function of the heart. Compared to simple CA, based on CA with LAAC intervention, it does not significantly change LA endocrine function but may lead to a decline in the LA reservoir function.

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“…This is accompanied by a significant 13% reduction in LA size and an improvement in LA Volume index which is an established predictor of adverse cardiovascular events 25,109,110 . More recently, these findings were replicated in the LAFIT‐WATCHMAN study 111 . This was however not reflected by strain imaging, which was attributed to the small sample size and relatively early assessment post‐procedure.…”

Section: Special Considerationsmentioning

confidence: 92%

Current practice and future prospects in left atrial appendage occlusion

Narasimhan

Aedma

Bhatia

et al. 2021

Pacing Clinical Electrophis

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The thromboembolic complications of Atrial fibrillation (AF) remain a major problem in contemporary clinical practice. Despite advances and developments in anticoagulation strategies, therapy is complicated by the high risk of bleeding complications and need for meticulous medication compliance. Over the past few decades, the left atrial appendage has emerged as a promising therapeutic target to prevent thromboembolic events while mitigating bleeding complications and compliance issues. Emerging data indicates that it is a safe, effective and feasible alternative to systemic anticoagulation in patients with non‐valvular AF. A number of devices have been developed for endocardial or epicardial based isolation of the left atrial appendage. Increasing experience has improved overall procedural safety and ease while simultaneously reducing device related complication rates. Furthermore, increasing recognition of the non‐mechanical advantages of this procedure has led to further interest in its utility for further indications beyond the prevention of thromboembolic complications. In this review, we present a comprehensive overview of the evolution of left atrial appendage occlusion, commercially available devices and the role of this modality in the current management of AF. We also provide a brief outline of the landmark trials supporting this approach as well as the ongoing research and future prospects of left atrial appendage occlusion

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Impact of left atrial appendage occlusion on left atrial function—The LAFIT Watchman study

Cited by 18 publications

References 15 publications

Effect of Left Atrial Appendage Closure in Combination With Catheter Ablation on Left Atrial Function for Persistent Atrial Fibrillation

Effect of Left Atrial Appendage Closure in Combination With Catheter Ablation on Left Atrial Function for Persistent Atrial Fibrillation

Impact of Left Atrial Appendage Closure Combined with Catheter Ablation on Endocrine and Mechanical Cardiac Function in Patients with Atrial Fibrillation

Current practice and future prospects in left atrial appendage occlusion

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