Hemodynamic impact of percutaneous left atrial appendage closure

Abstract

Percutaneous left atrial appendage closure (LAAC) has emerged as an alternative to reduce the risk of stroke for patients with non-valvular atrial fibrillation. It still remains however unclear whether LAAC can cause a potential hemodynamic impairment or not. Our retrospective monocentric study included 62 patients who underwent LAAC between 2015 and 2019. Patients were put into two groups based on new onset or worsening of heart failure (HF) signs within 12 months after LAAC procedure: HF patients ( n = 19) and no HF patients ( n = 49). In comparison with no HF patients, those who experienced new onset heart failure or worsening HF had lower left ventricular ejection fraction (LVEF) at presentation (no HF pts 60.7 ± 9% vs. HF pts 49.1 ± 12.5%, P < 0.001), higher left atrial diameter (3.6 ± 0.6 cm vs. 4.2 ± 0.5 cm, P < 0.001), higher left atrial area (26.5 ± 8 cm 2 vs. 32.1+/6.4 cm 2 , P < 0.01) and tended to have a higher left atrial volume index (52.8 ± 28 mL/m 2 vs. 62.4 ± 22 mL/m 2 , P = 0.07). 12 weeks after LAAC procedure, a B-type natriuretic peptide (BNP or NT-proBNP) increase > 30% was more frequently observed in HF patients (30.8% vs. 80%, P < 0.001) without significant difference in left atrial remodeling. Device-related thrombus was observed in 3 patients with HF (2,3% vs. 15,8%, P = 0,05) and residual peridevice leak in 4 patients (15,4% vs. 20%, P = 0,4). After 2 years of follow-up, Kaplan–Meier estimated that survival was not significantly different among these two groups. Our results suggested that monitoring possible occurrence of heart failure should be tested after LAAC, especially in the patients with previous HF. Further investigations concerning biological and imaging data predictive factors of heart failure in a large population are needed.