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Published on: February 26, 2013
Percutaneous left atrial appendage occlusion: impact on left atrial deformation indices
Andries P Dippenaar1, Jan A Saaiman2, Marshall J Heradien2,3
1SAEndovascular, Kuils River Netcare Hospital, Kuils River, Cape Town, South Africa. dradippenaar@gmail.com.
Insights
Left atrial appendage occlusion (LAAO) with Amplatzer or Amulet devices did not improve left atrial mechanics. This suggests different LAAO devices may have varying effects on atrial function, warranting further investigation into clinical implications.
Area of Science:
- Cardiology
- Medical Devices
- Atrial Fibrillation Management
Background:
- Percutaneous left atrial appendage occlusion (LAAO) offers an alternative to anticoagulation for atrial fibrillation (AF) patients.
- Previous studies showed mixed results on LA mechanics post-LAAO with different devices.
- The impact of Amplatzer or Amulet devices on LA deformation mechanics remained uninvestigated.
Purpose of the Study:
- To assess the effect of LAAO using Amplatzer or Amulet devices on echocardiographic left atrial (LA) deformation indices.
- To compare LA mechanical function before and after LAAO procedures.
Main Methods:
- Retrospective analysis of patients undergoing LAAO from 2013-2021.
- Echocardiographic assessment of LA reservoir, conduit, and contractile strain and strain rates using 2D speckle tracking.
- Statistical comparison of LA deformation indices pre- and post-procedure using linear mixed models.
Main Results:
- No significant changes were observed in LA reservoir, conduit, or contractile strain post-LAAO.
- LA strain rates also showed no significant improvement or changes after LAAO.
- The study analyzed 28 LAAO recipients with a mean follow-up of 1.6 months.
Conclusions:
- LAAO with Amplatzer or Amulet devices did not significantly alter LA mechanical function.
- Findings suggest potential device-specific differences in the impact on LA deformation.
- Further research is needed to understand the clinical significance of these divergent effects.
Background:
Percutaneous left atrial appendage occlusion (LAAO) is an accepted alternative to thromboprophylaxis in patients with atrial fibrillation (AF) who are: (i) intolerant to oral anticoagulation (OAC) (e.g. life-threatening haemorrhage), (ii) non-adherent to OAC, or (iii) at a high bleeding risk with OAC. Improvement in LA mechanics was shown post-LAAO in the LAFIT-LARIAT study, using the Lariat device. No significant change was seen in LA mechanics after LAAO with the Watchman device in the LAFIT-Watchman study. The impact of LAAO with the Amplatzer or Amulet device on LA deformation mechanics has not been investigated.
Purpose:
To evaluate the impact of LAAO with the Amplatzer or Amulet device on echocardiographic LA deformation indices.
Methods:
All patients undergoing percutaneous LAAO from 2013 to 2021 at a single centre were included from an ongoing clinical registry. LA reservoir (εreservoir), conduit (εconduit) and contractile strain (εcontractile) and strain rate (SRreservoir, SRconduit, SRcontractile) were assessed with two-dimensional speckle tracking echocardiography from an apical four-chamber view. Conduit and contractile strain and strain rates were only recorded for patients without AF at the time of echocardiography. Changes in LA deformation indices over time were compared with a linear mixed model.
Results:
28 LAAO recipients (mean age 73 ± 12 years, 68% male) were analysed. 5 (18%) patients had AF pre- or post-procedure. After a mean follow-up of 1.6 ± 1.4 months, the mean LA εreservoir increased from 10.15 ± 6.44% to 10.18 ± 8.72% (p = 0.985), the mean LA εconduit increased from 5.12 ± 5.48% to 5.31 ± 6.11% (p = 0.891) and the mean LA εcontractile decreased from 5.14 ± 4.32% to 4.95 ± 5.30% (p = 0.898). During the same time interval, the mean LA SRreservoir decreased from + 0.54 ± 0.23.s- 1 to + 0.48 ± 0.43.s- 1 (p = 0.566), the mean LA SRconduit remained stable: -0.47 ± 0.41.s- 1 to -0.47 ± 0.32.s- 1 (p = 0.997) and the mean LA SRcontractile decreased from - 0.66 ± 0.50.s- 1 to -0.55 ± 0.46.s- 1 (p = 0.660).
Conclusion:
No significant improvement in LA mechanical function was seen after LAAO with the Amplatzer or Amulet device. Different LAAO devices therefore appear to have divergent effects on LA deformation, the clinical implications of which may warrant further study.
