Association of transcatheter left atrial appendage occlusion with acute changes in left atrial pressure: An invasive hemodynamic study

Abstract

BackgroundThe hemodynamic effects of transcatheter left atrial appendage occlusion (LAAO) remain unclear. ObjectiveWe sought to assess the effect of LAAO on invasive hemodynamics and their correlation with clinical outcomes. MethodsWe recorded mean left atrial pressure (mLAP) before and after device deployment. We assessed the prevalence and predictors of mLAP increase after deployment, the association between significant mLAP increase after deployment and 45-day peridevice leak (PDL), and the association between mLAP increase and heart failure (HF) hospitalization. A significant mLAP increase was defined as one equal to or greater than the mean percentage increase in mLAP after deployment (≥28%). ResultsWe included 302 patients (36.4% female; mean age, 75.8 ± 9.5 years). After deployment, mLAP increased in 48% of patients, 38% of whom experienced significant mLAP increase. Independent predictors of mLAP increase were baseline mLAP ≤14 mm Hg, nonparoxysmal atrial fibrillation, and age per 5 years (odds ratios: 3.66 [95% CI, 2.21–6.05], 1.81 [95% CI, 1.08–3.02], and 0.85 [95% CI, 0.73–0.99], respectively). Significant mLAP increase was an independent predictor of 45-day PDL (odds ratio, 2.55; 95% CI, 1.04–6.26). There was no association between mLAP increase and HF hospitalization. ConclusionAfter deployment, mLAP acutely rises in 48% of patients, although this is not associated with increased HF hospitalizations. PDL is more likely to develop at 45 days in patients with significant increase in mLAP after deployment, although most leaks were small (<5 mm). These findings suggest that mLAP increase after deployment is not associated with major safety concerns. Additional studies are warranted to explore the long-term hemodynamic effects of LAAO.