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

Zhongbao Ruan; Fei Wang; Ge‐cai Chen; Jun‐guo Zhu; Yin Ren; Li Zhu

doi:10.7150/ijms.95080

January 1, 2024International Journal of Medical SciencesOpen Access

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

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Why the study?

The study aimed to investigate the long-term impact of left atrial appendage occlusion on cardiac function and structure in patients with non-valvular atrial fibrillation.

Does LAAO combined with ablation improve cardiac structure and function compared to LAAO alone in patients with non-valvular atrial fibrillation?

Structured PICO

Does LAAO combined with ablation improve cardiac structure and function compared to LAAO alone in patients with non-valvular atrial fibrillation?

P

Population

157 patients with non-valvular atrial fibrillation (NVAF) refractory to antiarrhythmic drugs, mean age 67.4, 58.0% male, CHA2DS2-VASc score ≥ 2 (male) or ≥ 3 (female), intolerant or contraindicated to long-term anticoagulation, at a single center in China.

I

Intervention

Left atrial appendage occlusion (LAAO) using Watchman 2.5 device combined with radiofrequency catheter ablation (RFCA) or cryoballoon ablation (Cryo)

C

Comparator

Left atrial appendage occlusion (LAAO) alone

O

Outcome

Changes in cardiac function and structure (LAAD, LVEDD, LVESD, LVEF, and plasma NT-proBNP) at 3, 6, and 12 months post-proceduresurrogate

LAAO combined with ablation significantly improves cardiac structure and function in patients with NVAF compared to LAAO alone, with the benefits primarily attributable to the ablation procedure.

Limitations

single-center follow-up study with a small sample size and inconsistent selection of patients at each time point
few parameters selected to reflect cardiac structure and function
factors such as drugs taken by patients and recurrence of AF may affect cardiac structure and function

Implication

May support adding ablation to LAAO for remodeling in NVAF; hypothesis-generating and requires randomized confirmation.

Abstract

The Aim of this study was to investigate the long-term impact of left atrial appendage occlusion (LAAO) on cardiac function and structure in patients with non-valvular atrial fibrillation (NVAF). 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 of LAAO on cardiac function and structure were evaluated. Results showed that the procedures were performed successfully with 6.4% complications. During follow-up, 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 procedure. There was a significant decrease of LAAD, LVEDD, left ventricular end-systolic dimension (LVESD) and NT-proBNP levels in combined group at 3 months, 6 months and 12 months post- procedure, while an increase of left ventricular ejection fraction (LVEF). Meanwhile, 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. In conclusion, 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 result of ablation, not LAAO.