Key result
LAAO linked to transient cardiac remodeling and a ~48% composite event rate over 5 years.
Why the study?
The long-term outcomes of LAAO and its impacts on cardiac electrical and mechanical remodeling remain to be learned.
What is the impact of left atrial appendage occlusion on long-term cardiac remodeling and cardiovascular outcomes in patients with nonvalvular atrial fibrillation?
Cohort (n=107)
No
What is the impact of left atrial appendage occlusion on long-term cardiac remodeling and cardiovascular outcomes in patients with nonvalvular atrial fibrillation?
LAAO does not cause permanent adverse electrical or mechanical atrial remodeling at 5 years, though patients remain at risk for long-term cardiovascular events and nonprocedure-related pericardial effusion.
We aimed to describe the impact of left atrial appendage occlusion (LAAO) on atrial remodeling and cardiovascular outcomes within 5-year follow-up. PATIENTS AND METHODS: A total of 107 patients with nonvalvular atrial fibrillation (NVAF) undergoing LAAO in the Shanghai Tenth People's Hospital between January 2014 and July 2017 were included. All participants were followed for ECG, transthoracic echocardiography (TTE), and clinical outcomes (including cardiovascular death, heart failure, ischemic stroke/systemic embolism, and pericardial effusion) at 6 and 12 months, and thereafter every 12 months after LAAO discharge until 5 years. RESULTS: After LAAO, the left atrial diameter significantly increased at 6 months (48.6 ± 6.7 vs 46.5 ± 7.0 mm); heart rate decreased immediately after the procedure (78.5 ± 14.7 vs 85.3 ± 21.7 bpm) when compared with the pre-procedure level. The QTc interval prolongated to the highest value of 460.7 ± 46.8 ms at 6 months (pre-procedure level of 433.7±49.0 ms). All these changes return to the pre-procedure level within the follow-up. For clinical outcomes, 51 patients suffered the composite of cardiovascular death (n=4, 3.7%), heart failure (n=25, 23.4%), ischemic stroke/systemic embolism (n=22, 20.6%), and pericardial effusion (n=26, 26.2%). CONCLUSION: LAAO did not change ECG or TTE characteristics and nonprocedure-related pericardial effusion is common during long-term follow-up. Further studies are warranted to investigate the optimal time frame of anticoagulation in patients undergoing LAAO.
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Liu et al. (2021) conducted a cohort in Nonvalvular atrial fibrillation (n=107). Left atrial appendage occlusion (LAAO) was evaluated on Composite of cardiovascular death, heart failure, ischemic stroke/systemic embolism, and pericardial effusion. Left atrial appendage occlusion was associated with transient cardiac remodeling that returned to baseline and a 47.7% rate of composite cardiovascular events or pericardial effusion over 5 years.
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