B-PO03-154 METABOLIC EFFECTS OF THE LEFT ATRIAL APPENDAGE EXCLUSION (THE HEART HORMONE STUDY)

Abstract

It is currently unknown whether the elimination of ANP and other neurohormone secretion from LAA in AF patients can have any consequences on long term physiological regulation of lipid and glucose metabolism, obesity, and insulin resistance. To investigate the lipid and glucose metabolism and acting on the metabolism of broader hormones and long-term follow-up covering 2 years in patients who undergone epicardial LAA closure procedure. In a single-center prospective observational study, 60 patients with longstanding persistent AF with cardiovascular risk factors had undergone an epicardial exclusion procedure. Anthropometric parameters and glucose, glycated hemoglobin (HbA1c), insulin, leptin, adiponectin, free fatty acids, beta-hydroxybutyrate, and total cholesterol levels were evaluated on fasting at baseline before the procedure and compared with levels at 24 hours, 7 days, 1 month, 3 months, 6 months, and 24 months after the procedure. Device implantation (LARIAT) was successful in all 60 patients. No complications were noted. Postprocedural transesophageal echocardiogram (TEE) showed complete LAA closure in all patients, no leak was observed. The group on average was insulin levels significantly increased at 7 days, 1 month, 3 months, 6 months, 12 months, and 24 months follow-up. The leptin levels showed a significant increase in 6 months, 12 months, and 24 months when compared to baseline. Whereas the adiponectin levels showed a significant decrease at 3 months, 6 months, 12 months, and 24 months when compared to baseline levels. In patients with the epicardial procedure, when compared to baseline, glucose, glycated hemoglobin, total cholesterol, and beta-hydroxybutyrate levels did not show any significant changes at baseline and 24 months follow up. The tendency of reduced weight was observed one year after the procedure (p = 0.084). The epicardial exclusion ligation in AF patients was associated with significant changes in insulin, leptin, and adiponectin over long follow up. It provides preliminary data that demonstrates the impact of LAA exclusion on various hormones or cytokines that can affect the insulin resistance, lipid, and glucose metabolism regulation in the body.