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Updated: Nov 4, 2025
Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation
Published on: February 26, 2013
Hemodynamic effects of left atrial appendage occlusion
Esseim Sharma1, Eirini Apostolidou2, Wasiq Sheikh2
1Department of Cardiology, The Warren Alpert Medical School of Brown University, Providence, RI, USA. esseim.sharma@lifespan.org.
Insights
Percutaneous left atrial appendage occlusion (LAAO) improves cardiac function, showing enhanced left ventricular ejection fraction and altered strain patterns. This minimally invasive procedure offers a new approach for stroke prevention in non-valvular atrial fibrillation patients.
Area of Science:
- Cardiology
- Medical Devices
- Echocardiography
Background:
- Percutaneous left atrial appendage occlusion (LAAO) offers an alternative to anticoagulation for stroke prevention in non-valvular atrial fibrillation (NVAF).
- The left atrial appendage's role in cardiovascular homeostasis via neuroendocrine hormones is recognized.
- Hemodynamic effects of LAA occlusion on cardiac function require further characterization.
Purpose of the Study:
- To evaluate the hemodynamic impact of percutaneous LAAO on cardiac function using echocardiography.
- To assess changes in left ventricular ejection fraction, diastolic parameters, and atrial/ventricular strain post-LAAO.
Main Methods:
- Retrospective analysis of 67 patients undergoing LAAO with the WATCHMAN device.
- Pre- and post-procedural 2D transthoracic echocardiograms (TTE) were performed.
- Key echocardiographic parameters including LVEF, E/e', RVGLS, and PALS were statistically analyzed.
Main Results:
- Significant improvement in left ventricular ejection fraction (LVEF) post-LAAO (p < 0.001).
- Increased mitral E/e' suggesting altered LV filling pressures (p < 0.001).
- Significant decrease in right ventricular global longitudinal strain (RVGLS) (p = 0.027) and improvement in peak left atrial longitudinal strain (PALS) (p = 0.040).
Conclusions:
- Percutaneous LAAO induces real-time hemodynamic changes in the atria and ventricles.
- Echocardiographic parameters like E/e', PALS, RVGLS, and LVEF effectively assess these hemodynamic shifts.
- LAAO demonstrates a measurable impact on cardiac function beyond stroke risk reduction.
Background:
Percutaneous left atrial appendage occlusion (LAAO) devices have emerged as alternatives to anticoagulation for embolic stroke prevention in patients with non-valvular atrial fibrillation (NVAF). The left atrial appendage is known to produce vasoactive neuroendocrine hormones involved in cardiovascular homeostasis. The hemodynamic impact of LAA occlusion on cardiac function remains poorly characterized.
Methods:
This is a single-center, retrospective study of sixty-seven consecutive patients who received LAAO utilizing the WATCHMAN device from May 2017 to June 2019. All patients received a comprehensive 2D transthoracic echocardiogram (TTE) prior to the procedure and a post-procedural TTE. 2D echocardiographic pre-/post-procedural measurements including left ventricular ejection fraction, tricuspid regurgitation, estimated pulmonary artery pressure, diastolic parameters, and left atrial and right ventricular strain were statistically analyzed using the paired t-test.
Results:
Seventy percent of study patients were male with an overall mean age of 73.0 ± 9.0 years. Analysis of post-procedural LAAO revealed statistically significant improvement in left ventricular ejection fraction (52.4 ± 12.6 vs. 56.7 ± 12.7, p < 0.001), an increase in mitral E/e' (14.1 ± 6.5 vs. 18.3 ± 10.8, p < 0.001), and a decrease right ventricular global longitudinal strain (RVGLS) (- 17.5 ± 4.6 vs. - 19.6 ± 5.7, p = 0.027) as compared to pre-procedural TTE. Peak left atrial longitudinal strain (PALS) improved post-LAAO (20.6 ± 12.2 to 22.9 ± 12.9, p = 0.040) with adjustment for cardiac arrhythmias. Post-LAAO, heart failure hospitalizations occurred in 23.9% of patients.
Conclusions:
Percutaneous LAAO results in real-time atrial and ventricular hemodynamic changes as assessed by echocardiographic evaluation of LV filling pressures (E/e'), PALS, RVGLS, and LVEF.
