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Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation
Published on: February 26, 2013
The influence of iatrogenic interatrial septum leaks after left atrial appendage closure on cardiac function test
Katarzyna Mitrega1, Witold Streb1, Magdalena Szymala1
1Department of Cardiology, Congenital Heart Diseases, and Electrotherapy Medical University of Silesia, Silesian Center of Heart Diseases, Zabrze, Poland.
Insights
Iatrogenic transseptal leaks after left atrial appendage occlusion (LAAO) do not affect overall cardiac function. However, these leaks improve oxygen consumption and walking distance in heart failure patients.
Area of Science:
- Cardiology
- Medical Devices
- Interventional Cardiology
Background:
- Left atrial appendage occlusion (LAAO) is a key strategy for preventing thromboembolism in patients with atrial fibrillation and high bleeding risk.
- Iatrogenic transseptal leaks (ITLs) can persist after LAAO procedures.
- The clinical significance of ITLs on cardiac function remains an area of investigation.
Purpose of the Study:
- To investigate the correlation between the incidence of ITLs after LAAO and cardiac function test outcomes.
- To analyze the impact of ITLs on exercise capacity in patients undergoing LAAO.
Main Methods:
- A cohort of 62 patients undergoing LAAO with the Amplatzer Amulet device were studied.
- Cardiac function was assessed using the 6-minute walking distance (6MWD) test and maximal oxygen consumption (VO2max) before and 3 months after LAAO.
- Transesophageal echocardiography was used to detect ITLs before and after the procedure.
Main Results:
- While ITLs did not impact overall cardiac function tests, patients with heart failure (HF) and ITLs showed significant improvements in VO2max and 6MWD post-LAAO.
- Patients with transseptal leaks demonstrated significantly higher 6MWD compared to those without leaks.
- Improvements in VO2max and 6MWD in HF patients with ITLs suggest a reduction in left atrial pressure.
Conclusions:
- The presence of ITLs after LAAO does not adversely affect overall cardiac function.
- In heart failure patients, ITLs are associated with improved exercise capacity, likely due to decreased left atrial pressure.
- These findings suggest a potential beneficial hemodynamic effect of ITLs in select heart failure populations.
Aim:
Left atrial appendage occlusion (LAAO) is a technique for preventing thromboembolism in patients with atrial fibrillation and a high risk of irreversible bleeding. In some patients, a spontaneous iatrogenic transseptal leak (ITL) remains after LAAO. The aim of this study was to assess the correlation between ITL incidence and the results of cardiac function tests in patients who underwent LAAO.
Methods And Results:
LAOO was performed in 62 consecutive patients using the Amplatzer Amulet. Before and 3 months after LAA occlusion, the 6-min walking distance (6MWD) test was performed in all patients and oxygen consumption assessment (VO2max ) was performed in 32. All patients had transesophageal echocardiography before and 3 months after LAAO to assess ITL incidence. The patients were divided according to the presence and absence of ITL and the subgroup of patients with heart failure (HF) were further analyzed. In patients with HF and ITL, an increased VO2max (12.8 ± 5.2 vs 15.3 ± 4.7; P < 0.05) and 6MWD (350.1 ± 77.4 vs 414.3 ± 70.6; P < 0.05) was observed after the procedure comparing to the results before the procedure. The 6MWD was also significantly higher in the patients with transseptal leaks in comparison to those without (P < 0.0001).
Conclusion:
The presence of transseptal leaks after LAAO does not influence overall cardiac function test results. However, in patients with HF, there is an increase in oxygen consumption and 6MWD. These results indicate that ITLs in patients with HF decrease left atrial pressure, which is the key contributor to the symptoms of heart failure during physical activity.
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