Association of Transcatheter Left Atrial Appendage Occlusion with Acute Changes in Left Atrial Pressure: An Invasive Hemodynamic Study.

BACKGROUND

The hemodynamic effects of transcatheter left atrial appendage occlusion (LAAO) remain unclear.

OBJECTIVE

We sought to assess the effect of LAAO on invasive hemodynamics and their correlation with clinical outcomes.

METHODS

We recorded mean left atrial pressure (mLAP) before and after device deployment. We assessed: (a) the prevalence and predictors of mLAP increase post-deployment; (b) the association between significant mLAP increase post-deployment and 45-day peridevice leak (PDL); (c) the association between mLAP increase and heart failure (HF) hospitalization. Significant mLAP increase was defined as one equal to or greater than the mean percentage increase in mLAP post-deployment (≥28%).

RESULTS

We included 302 patients (36.4% female; mean age, 75.8±9.5 years). Post-deployment, mLAP increased in 48.0% of patients, 38.0% of whom experienced significant mLAP increase. Independent predictors of mLAP increase were baseline mLAP ≤14 mmHg, non-paroxysmal atrial fibrillation, and age (odds ratios: 3.66; 95%CI 2.21-6.05, 1.81; 95%CI 1.08-3.02, and 0.85 (per 5 years); 95%CI 0.73-0.99, respectively). Significant mLAP increase was an independent predictor of 45-day PDL (OR: 2.55; 95%CI 1.04-6.26). There was no association between mLAP increase and HF hospitalization.

CONCLUSION

MLAP acutely rises in 48% of patients post-deployment, although this is not associated with increased HF hospitalizations. Patients with significant increase in mLAP post-deployment are more likely to develop PDL at 45 days, albeit most leaks were small (<5 mm). These findings suggest that mLAP increase post-deployment is not associated with major safety concerns. Additional studies are warranted to explore the long-term hemodynamic effects of LAAO.

Informations de copyright

Copyright © 2024. Published by Elsevier Inc.