0290: Left atrial remodeling after percutaneous left atrial appendage closure

Abstract

The importance of the left atrial appendage (LAA) on left atrial (LA) hemodynamics is unknown. We sought to evaluate the effect of LAA percutaneous closure (LAAPC) on left atrial remodeling in patients with paraxysmal atrial fibrillation (AF) and permanent AF. All patients refered for LAAPC with Amplatzer Cardiac Plug (ACP) and Watchman device were enrolled. Cardiac computed tomography (CT) for LA volume measurement and transthoracic echocardiography (TTE) for diastolic function assessment were performed at baseline and 3 months after LAAPC. An average of 3 consecutives measurements were performed for TEE parameters in all patients. Sixty-three patients (mean age 73±9 years) were included. 38% (n=24) in sinus rythm (SR) at baseline and 55% (n=35) in permanent AF. Patients in SR at baseline and permanent AF at 3 months were excluded (n=4,7%).The mean CHA2DS2-VASc score was 4,3±1,3. There was non significant difference in the functionnal status and BNP level (155,6±107 vs ±150,7pg/mL; p=0,85) between baseline and 3 months follow-up. Left atrial volume excluding the LAA (145 ±55cm 3 baseline vs 144±50cm 3 at 3 months; p=0,30) showed no significant change after 3 months in overall population, neither in the SR (99,7±19,1 vs 103,8±21cm 3 ; p=0,32) or the permanent AF groups (173,2±54 vs 171,7±48,6cm 3 ; p=0,59). MV peak E-wave (84,2±22,7 vs 86,7±26cm/s; p=0,62) and A-wave velocities (65,4±14,4; 68,5±22,2cm/s; p=0,66) dit not differ between baseline and follow-up but E/E’ ratio was increased in the overall population after LAAPC (7,9±2,1 vs 9,1±3,6cm/s; p=0,038) and there was trend to higher E/E’ ratio in the SR group (7,7±1,6 vs 9±3,3cm/s, p=0,46). There’s no evidence for early LA remodeling after LAAPC, but diastolic function might be negatively influenced by LAAPC suggesting the potential role of LAA in atrial function. Further studies are warranted to confirm the prelimary results.