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Updated: Jul 9, 2026
The WATCHMAN Left Atrial Appendage Closure Device for Atrial Fibrillation
Published on: February 28, 2012
Association of transcatheter left atrial appendage occlusion with acute changes in left atrial pressure: An invasive
Hasan S Alarouri1, Gerardo V Lo Russo1, Alejandra Chavez Ponce1
1Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota.
Insights
Transcatheter left atrial appendage occlusion (LAAO) can increase mean left atrial pressure (mLAP) in nearly half of patients. This increase is linked to peridevice leak but not heart failure hospitalizations, suggesting LAAO is generally safe.
Area of Science:
- Cardiology
- Interventional Cardiology
- Medical Devices
Background:
- Hemodynamic effects of transcatheter left atrial appendage occlusion (LAAO) are not well understood.
- Assessing these effects is crucial for understanding LAAO's impact on patient outcomes.
Purpose of the Study:
- To evaluate the impact of LAAO on invasive hemodynamics, specifically mean left atrial pressure (mLAP).
- To determine the correlation between hemodynamic changes and clinical outcomes like peridevice leak (PDL) and heart failure (HF) hospitalization.
Main Methods:
- Invasive hemodynamics, including mLAP, were measured before and after LAAO device deployment in 302 patients.
- Analysis focused on the prevalence, predictors, and clinical associations of mLAP increase post-deployment.
- Significant mLAP increase was defined as ≥28% rise from baseline.
Main Results:
- mLAP increased in 48% of patients post-LAAO; a significant increase (≥28%) occurred in 38% of these.
- Predictors of mLAP increase included lower baseline mLAP, nonparoxysmal atrial fibrillation, and older age.
- Significant mLAP increase independently predicted 45-day PDL (OR 2.55), but no association was found with HF hospitalization.
Conclusions:
- Acutely, mLAP rises in nearly half of patients after LAAO, but this is not linked to increased HF hospitalizations.
- Significant mLAP increase is associated with a higher likelihood of PDL at 45 days, though most leaks are small.
- These findings suggest LAAO is safe regarding acute hemodynamic changes, but long-term effects require further investigation.
Background:
The hemodynamic effects of transcatheter left atrial appendage occlusion (LAAO) remain unclear.
Objective:
We sought to assess the effect of LAAO on invasive hemodynamics and their correlation with clinical outcomes.
Methods:
We recorded mean left atrial pressure (mLAP) before and after device deployment. We assessed the prevalence and predictors of mLAP increase after deployment, the association between significant mLAP increase after deployment and 45-day peridevice leak (PDL), and the association between mLAP increase and heart failure (HF) hospitalization. A significant mLAP increase was defined as one equal to or greater than the mean percentage increase in mLAP after deployment (≥28%).
Results:
We included 302 patients (36.4% female; mean age, 75.8 ± 9.5 years). After deployment, mLAP increased in 48% of patients, 38% of whom experienced significant mLAP increase. Independent predictors of mLAP increase were baseline mLAP ≤14 mm Hg, nonparoxysmal atrial fibrillation, and age per 5 years (odds ratios: 3.66 [95% CI, 2.21-6.05], 1.81 [95% CI, 1.08-3.02], and 0.85 [95% CI, 0.73-0.99], respectively). Significant mLAP increase was an independent predictor of 45-day PDL (odds ratio, 2.55; 95% CI, 1.04-6.26). There was no association between mLAP increase and HF hospitalization.
Conclusion:
After deployment, mLAP acutely rises in 48% of patients, although this is not associated with increased HF hospitalizations. PDL is more likely to develop at 45 days in patients with significant increase in mLAP after deployment, although most leaks were small (<5 mm). These findings suggest that mLAP increase after deployment is not associated with major safety concerns. Additional studies are warranted to explore the long-term hemodynamic effects of LAAO.
