Abstract 17620: Progressive Volume Retention Requiring an Increase in Loop Diuretic Use After Watchman Implant: A Retrospective Case Control Study

Abstract

Introduction: Some patients with atrial fibrillation and high stroke risk cannot be anticoagulated. Percutaneous left atrial appendage occlusion (LAAO) is a potential alternative stroke risk reduction strategy. The LAA secretes ANP which has neurohormonal effects on fluid balance, but the effects of LAAO on clinical volume status remains uncertain. Goals: We expanded upon our prior data reporting a rise in diuretic use after LAAO by including a control cohort of patients without LAAO. Methods: Retrospective clinical data from patients who underwent LAAO at our institution from 2015-2020 with Watchman 2.5 (n=151, 38% female) and Watchman FLX patients from 2020-2022 (n=80, 31% female) were analyzed. A control group consisting of patients with atrial fibrillation who have not had LAAO were included (n=186, 38% female). Data extracted included demographics, loop diuretic dose, LVEF, and presence of HTN, CAD, PAD, DM, CKD, TIA/CVA. Progressive volume retention was defined as initiation or increase in loop diuretic dose within 12 months of LAAO, or within last 12 months from most recent cardiology visit for controls. Results: There was no significant difference in clinical variables between the two groups except for a significantly high proportion of TIA/CVA in LAAO group (p=0.003) and CKD and HF in the control group (p=0.031 and 0.004, respectively). Specifically, 49/231 (21.2%) of the LAAO cohort showed a rise in loop diuretic requirements compared to 27/186 (14.5%) of the controls (p = 0.078). There were 17/231 (7.4%) new loop diuretic prescriptions in the LAAO group compared to 6/186 (3.2%) for the controls (p = 0.066). In multivariable analyses controlling for age, sex, BMI, preimplant LVEF, prior HF, CKD, and LAAO, only age, prior HF, and LAAO predicted a rise in loop diuretic in subsequent year after implant. The strongest predictors were the presence of prior HF, OR 2.32 (95% CI 1.28-4.21, p = 0.005) and LAAO, OR 1.9 (95% CI 1.09-3.27, p = 0.023). Conclusions: These results suggest that LAAO is associated with an almost two-fold increased risk of clinically relevant volume retention. This risk appears to be highest among patients with a clinical history of HF. These findings may inform preimplantation discussions and post-LAAO expectations and clinical management.