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Updated: Mar 7, 2026
Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation
Published on: February 26, 2013
Percutaneous left atrial appendage closure improves left atrial mechanical function through Frank-Starling mechanism
Augustin Coisne1, Rosario Pilato2, François Brigadeau3
1Department of Echocardiography and Cardiovascular Explorations, CHU Lille, Lille, France; European Genomic Institute for Diabetes (E.G.I.D), Lille, France; Univ. Lille, F-59000 Lille, France; INSERM UMR 1011, Lille, France; Institut Pasteur de Lille, Lille, France.
Left atrial appendage (LAA) closure significantly improves left atrial (LA) reservoir and contractile function. These enhancements are attributed to altered loading conditions, suggesting a Frank-Starling mechanism rather than intrinsic contractility changes.
Area of Science:
- Cardiology
- Medical Imaging
- Electrophysiology
Background:
- Left atrial appendage (LAA) exclusion is known to alter left atrial (LA) flow dynamics.
- Previous studies, including a PROTECT AF substudy, indicated improved quality of life post-LAA closure.
Purpose of the Study:
- To investigate the impact of LAA closure on the transport function of the left atrium.
- To assess changes in LA mechanical function following LAA closure.
Main Methods:
- Prospective transthoracic echocardiography (2D/3D, 2D speckle tracking) was performed in 33 patients.
- Evaluations were conducted before LAA closure, at discharge, and 45 days post-procedure.
Main Results:
- LAA closure significantly improved LA reservoir function, evidenced by increased maximum LA volume index, 2D-LA reservoir volume, expansion index, and peak atrial longitudinal strain (PALS).
- LA contractile function also improved, shown by increased LA ejection fraction and peak atrial contraction strain (PACS) in sinus rhythm patients.
- The relationship between PACS and PALS remained constant, indicating improvement via the Frank-Starling effect.
Conclusions:
- Left atrial appendage closure is associated with enhanced LA mechanical function.
- Observed improvements in LA function appear to be secondary to modified loading conditions, consistent with a Frank-Starling effect.
