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Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation
Published on: February 26, 2013
Long Term Impact of Epicardial Left Atrial Appendage Ligation on Systemic Hemostasis: LAA HOMEOSTASIS-2
Krzysztof Bartus1,2, Sri Harsha Kanuri3, Radoslaw Litwinowicz1,2
1Department of Cardiovascular Surgery and Transplantology, Jagiellonian University Medical College, John Paul Hospital, ul. Pradnicka 80, 31-202 Krakow, Poland.
Insights
Epicardial left atrial appendage closure (LAAC) in atrial fibrillation (AF) patients leads to lasting neurohormonal changes. These persistent effects contribute to a significant reduction in blood pressure over two years.
Area of Science:
- Cardiology
- Interventional Cardiology
- Neuroendocrinology
Background:
- Epicardial left atrial appendage closure (LAAC) shows short-term neurohormonal effects.
- Long-term neurohormonal impacts of epicardial LAAC remain largely uncharacterized.
Purpose of the Study:
- To evaluate the long-term effects of percutaneous epicardial LAAC using the LARIAT device on neurohormonal profiles.
- To assess changes in adrenergic system hormones, renin-angiotensin-aldosterone system (RAAS), and natriuretic peptides.
Main Methods:
- Prospective single-center study involving 60 patients with persistent atrial fibrillation (AF).
- LARIAT device used for epicardial LAAC.
- Neurohormonal markers assessed at baseline and over a two-year follow-up period.
Main Results:
- Significant reductions in noradrenaline, epinephrine, plasma renin activity, and aldosterone observed long-term.
- Atrial natriuretic peptide (ANP) levels showed transient changes.
- Endothelin-1 and vasopressin levels demonstrated significant alterations.
- Sustained decrease in systolic and diastolic blood pressure noted up to two years post-intervention.
Conclusions:
- Epicardial LAAC in AF patients induces persistent neurohormonal modifications.
- These neurohormonal changes are associated with favorable long-term blood pressure reduction.
Background:
Recent data suggest that epicardial left atrial appendage closure (LAAC) is associated with several short-term neurohormonal effects. However, the long-term effects are currently unknown.
Objective:
To investigate the effects of percutaneous epicardial left atial appendage (LAA) exclusion using LARIAT on neurohormonal profiles at long-term follow-up.
Methods:
In a prospective single centre study, 60 patients with long-standing, persistent atrial fibrillation (AF) LARIAT were treated. The major hormones of the adrenergic system, renin-angiotensin-aldosterone system (RAAS), and natriuretic peptides were assessed before the intervention and at regular intervals during the following two years.
Results:
In patients with epicardial LAAC, atrial natriuretic peptide (ANP) levels were significantly increased from baseline at 24 h and decreased at 7 days, 1 month, and 3 months, while remaining unchanged at 12 and 24 months. Noradrenaline levels were significantly lower at 24 h, 7 days, 1 month, 6 months, 12 months, and 24 months, while epinephrine levels decreased significantly at 1 month, 6 months, 12 months, and 24 months. Plasma renin activity significantly decreased at 7 days, 1 month, 6 months, 12 months, and 24 months, while aldosterone levels significantly decreased at 6 months, 12 months, and 24 months. Endothelin-1 and vasopressin showed a significant increase and decrease, respectively, at 24 h, 7 days, 1 month, 6 months, 12 months, and 24 months. There was also a significant decrease in systolic and diastolic blood pressure at 3 months, 6 months, 1 year, and 2 years after the intervention.
Conclusions:
Epicardial LAAC in AF patients is associated with persistent neurohormonal changes favouring blood pressure reduction.
