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Updated: Nov 8, 2025
Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation
Published on: February 26, 2013
Five-Year Outcomes and Cardiac Remodeling Following Left Atrial Appendage Occlusion
Baoxin Liu1, Jiachen Luo1, Mengmeng Gong1
1Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, People's Republic of China.
Insights
Left atrial appendage occlusion (LAAO) in nonvalvular atrial fibrillation (NVAF) patients did not alter cardiac remodeling long-term. However, non-procedure-related pericardial effusion was common, necessitating further study on anticoagulation timing.
Area of Science:
- Cardiology
- Medical Devices
- Interventional Cardiology
Background:
- Left atrial appendage occlusion (LAAO) is an alternative to oral anticoagulants (OACs) for stroke prevention in nonvalvular atrial fibrillation (NVAF).
- Long-term outcomes and effects of LAAO on cardiac remodeling require further investigation.
Purpose of the Study:
- To evaluate the 5-year impact of LAAO on atrial remodeling.
- To assess cardiovascular outcomes following LAAO in NVAF patients.
Main Methods:
- 107 NVAF patients undergoing LAAO were followed for 5 years.
- Evaluations included ECG, transthoracic echocardiography (TTE), and clinical outcomes (cardiovascular death, heart failure, stroke/embolism, pericardial effusion).
Main Results:
- LAAO did not significantly alter ECG or TTE characteristics long-term.
- Temporary changes in left atrial diameter, heart rate, and QTc interval were observed but returned to baseline.
- Common adverse events included nonprocedure-related pericardial effusion (26.2%), heart failure (23.4%), and ischemic stroke/systemic embolism (20.6%).
Conclusions:
- LAAO does not appear to change cardiac remodeling parameters over 5 years.
- Nonprocedure-related pericardial effusion is a frequent complication.
- Optimal anticoagulation strategies post-LAAO require further research.
Purpose:
LAAO has been an alternative therapy to oral anticoagulants (OACs) for stroke prophylaxis in patients with nonvalvular atrial fibrillation (NVAF) with elevated CHA2DS2-Vasc score, but the long-term outcomes of LAAO and its impacts on cardiac electrical and mechanical remodeling remain to be learned. We aimed to describe the impact of left atrial appendage occlusion (LAAO) on atrial remodeling and cardiovascular outcomes within 5-year follow-up.
Patients And Methods:
A total of 107 patients with nonvalvular atrial fibrillation (NVAF) undergoing LAAO in the Shanghai Tenth People's Hospital between January 2014 and July 2017 were included. All participants were followed for ECG, transthoracic echocardiography (TTE), and clinical outcomes (including cardiovascular death, heart failure, ischemic stroke/systemic embolism, and pericardial effusion) at 6 and 12 months, and thereafter every 12 months after LAAO discharge until 5 years.
Results:
After LAAO, the left atrial diameter significantly increased at 6 months (48.6 ± 6.7 vs 46.5 ± 7.0 mm); heart rate decreased immediately after the procedure (78.5 ± 14.7 vs 85.3 ± 21.7 bpm) when compared with the pre-procedure level. The QTc interval prolongated to the highest value of 460.7 ± 46.8 ms at 6 months (pre-procedure level of 433.7±49.0 ms). All these changes return to the pre-procedure level within the follow-up. For clinical outcomes, 51 patients suffered the composite of cardiovascular death (n=4, 3.7%), heart failure (n=25, 23.4%), ischemic stroke/systemic embolism (n=22, 20.6%), and pericardial effusion (n=26, 26.2%).
Conclusion:
LAAO did not change ECG or TTE characteristics and nonprocedure-related pericardial effusion is common during long-term follow-up. Further studies are warranted to investigate the optimal time frame of anticoagulation in patients undergoing LAAO.
