Comparison of cardiac function and structure after left atrial appendage occlusion without versus with ablation in patients with non-valvular atrial fibrillation: a retrospective study

Background Regarding the physiology role of left atrial appendage (LAA), whether occlusion of LAA or combined with ablation has any influence on cardiac function and structure in patients with non-valvular atrial fibrillation (NVAF) is still unclear. Aims To compare the influence on cardiac function and structure after left atrial appendage occlusion (LAAO) without versus with ablation in patients with NVAF. Methods 157 patients with NVAF who underwent LAAO or combined with ablation were included and divided into Simple LAAO group or Combined group. Long term impact on cardiac function and structure between the two groups were compared. Results There was a significant decrease of left atrial anteroposterior diameter (LAAD) at 6 months and a significant increase of left ventricular end-diastolic dimension (LVEDD) at 12 months after LAAO. A significant decrease in plasma N-terminal pro-brain natriuretic peptide (NT-proBNP) was noted at 3 months, 6 months and 12 months after LAAO. Subgroup analysis indicated that there was a significant decrease of LAAD, LVEDD, LVESD and NT-proBNP levels in Combined group at 3 months, 6 months and 12 months post-procedure, while an increase of LVEF. However, no significant change of LAAD, LVEDD, LVESD, NT-proBNP and LVEF was seen in Simple LAAO group at 3 months follow-up, but a decrease of NT-proBNP during 6 months and 12 months follow-up. Compared with Simple LAAO group, Combined group was associated with a significant increase of residual flow. Conclusions LAAO has no significant effect on cardiac structure and function but can significantly reduce NT-proBNP. The improvement of cardiac structure and function in combined therapy comes from the influence of ablation, not LAAO.