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The WATCHMAN Left Atrial Appendage Closure Device for Atrial Fibrillation
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Epicardial Left Atrial Appendage Exclusion Reduces Blood Pressure in Patients With Atrial Fibrillation

Mohit K Turagam1, Venkat Vuddanda2, Niels Verberkmoes3

  • 1Department of Cardiology, Icahn School of Medicine at Mount Sinai, New York, New York.

Journal of the American College of Cardiology
|September 15, 2018
PubMed

Insights

Epicardial left atrial appendage exclusion (LAAE) significantly lowers systolic blood pressure in hypertensive patients with atrial fibrillation (AF) compared to endocardial LAAE. This blood pressure reduction is sustained at both 3 and 12 months post-procedure.

Area of Science:

  • Cardiology
  • Medical Devices
  • Interventional Cardiology

Background:

  • Percutaneous left atrial appendage exclusion (LAAE) is an emerging strategy for stroke prevention in atrial fibrillation (AF).
  • Observational studies suggest epicardial LAAE impacts arrhythmia burden and hemodynamics.

Purpose of the Study:

  • To compare the impact of epicardial versus endocardial LAAE on systemic blood pressure in hypertensive AF patients.
  • To evaluate changes in systolic and diastolic blood pressure, electrolytes, and creatinine.

Main Methods:

  • Prospective, nonrandomized study comparing 247 patients with epicardial LAAE and 124 patients with endocardial exclusion.
  • Clinical outcomes assessed at 3 months and 1 year.
  • Primary outcome: improvement in systolic blood pressure (SBP) from baseline.

Main Results:

  • No significant baseline SBP difference between groups.
  • Epicardial LAAE group showed significantly lower SBP at 3 months (122 vs. 130 mm Hg) and 1 year (123 vs. 132 mm Hg).
  • Epicardial LAAE significantly decreased SBP by 7.4 mm Hg at 3 months and 8.9 mm Hg at 1 year; a trend towards lower diastolic pressure was observed.

Conclusions:

  • Epicardial LAAE significantly reduces systolic blood pressure in hypertensive AF patients compared to endocardial exclusion.
  • The blood pressure-lowering effect is evident at 3 and 12 months post-procedure.
Abstract

Keywords:
atrial fibrillationhypertensionleft atrial appendagerenin-angiotensin-aldosterone system

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