Long Term Impact of Epicardial Left Atrial Appendage Ligation on Systemic Hemostasis: LAA HOMEOSTASIS-2

Abstract

Background: Recent data suggest that epicardial left atrial appendage closure (LAAC) is associated with several short-term neurohormonal effects. However, the long-term effects are currently unknown. Objective: To investigate the effects of percutaneous epicardial left atial appendage (LAA) exclusion using LARIAT on neurohormonal profiles at long-term follow-up. Methods: In a prospective single centre study, 60 patients with long-standing, persistent atrial fibrillation (AF) LARIAT were treated. The major hormones of the adrenergic system, renin-angiotensin-aldosterone system (RAAS), and natriuretic peptides were assessed before the intervention and at regular intervals during the following two years. Results: In patients with epicardial LAAC, atrial natriuretic peptide (ANP) levels were significantly increased from baseline at 24 h and decreased at 7 days, 1 month, and 3 months, while remaining unchanged at 12 and 24 months. Noradrenaline levels were significantly lower at 24 h, 7 days, 1 month, 6 months, 12 months, and 24 months, while epinephrine levels decreased significantly at 1 month, 6 months, 12 months, and 24 months. Plasma renin activity significantly decreased at 7 days, 1 month, 6 months, 12 months, and 24 months, while aldosterone levels significantly decreased at 6 months, 12 months, and 24 months. Endothelin-1 and vasopressin showed a significant increase and decrease, respectively, at 24 h, 7 days, 1 month, 6 months, 12 months, and 24 months. There was also a significant decrease in systolic and diastolic blood pressure at 3 months, 6 months, 1 year, and 2 years after the intervention. Conclusions: Epicardial LAAC in AF patients is associated with persistent neurohormonal changes favouring blood pressure reduction.

Safety and feasibility of left atrial appendage inversion in swine: A proof-of-concept study for potential therapy to prevent embolic stroke

“… Lakkireddy et al (2018) found that epicardial LAA device implantation lowered blood pressure, while ANP secretion was temporarily inhibited but finally recovered at 3 months postoperatively in these patients. Bartus et al (2022) reached similar findings. Other studies reported increased ( Behnes et al, 2017 ) or decreased ( Luani et al, 2018 ) ANP levels at 6 months after endocardial LAA closure.…”

Sociodemographic disparities in concomitant left atrial appendage occlusion during cardiac valve operations

“…However, increasing evidence from randomized controlled trials in recent years have consistently found lower risk of ischemic stroke and systemic embolism among patients with AF undergoing concomitant LAAO and cardiac procedures [ 11 , 21 , 34 ]. Literature suggests that LAAO may improve fibrin clot permeability and susceptibility to lysis in the cardiovascular system [ 35 ]. Additionally, LAAO has been associated with neurohormonal changes in the renin-angiotensin-aldosterone system favoring blood pressure reduction [ 36 ], potentially underlying the improvement in renal, cardiac, respiratory, and septic complications observed in our study.…”

Predicting the Absolute Risk of Ischemic Stroke in Asian Patients with Atrial Fibrillation: Comparing the COOL-AF Risk Score with CARS/mCARS Models for Absolute Risk and the CHA2DS2-VASc Score

“…Results from a nationwide study in the United States indicated that endocardial approach seemed to have a lower complication rate than the epicardial approach [ 29 ]. The new discoveries in LAAOs might further elevate the need for new and much more precise risk scores, such as altered coagulation factors and fibrinolytic activity in the left atrial appendage [ 30 ], metabolic effects of the left atrial appendage exclusion [ 31 ], and the systemic hemostasis that might be affected after left atrial appendage ligations [ 32 ].…”