Left atrial appendage clipping significantly reduced mean systolic blood pressure from 127.3 mmHg to 116.9 mmHg, an effect potentially mediated by increased B-type natriuretic peptide.
Observational (n=99)
No
Left atrial appendage clipping induces a significant and sustained reduction in blood pressure, likely mediated by increased BNP release and subsequent aldosterone suppression, necessitating postoperative antihypertensive medication adjustment.
Absolute Event Rate: 116.9% vs 127.3%
p-value: p=<0.001
Background: Atrial fibrillation (AF) is associated with an increased risk of thromboembolism, primarily due to thrombus formation in the left atrial appendage (LAA). While anticoagulation represents the standard therapy, patients with a high risk of bleeding require alternative strategies such as LAA clipping (LAAC); hypotension has been observed in some patients post-LAAC. This study aimed to investigate the hypotensive effect after LAAC in patients with AF, and to explore the potential mediating role of B-type natriuretic peptide (BNP). Methods: A retrospective single-center analysis was conducted on 99 patients who underwent a standalone totally thoracoscopic LAAC. Plasma BNP levels, aldosterone, electrolyte levels, and blood pressure were measured preoperatively and at defined intervals postoperatively. Echocardiographic parameters and medication use were also analyzed. Results: A significant increase in BNP level was observed following LAAC (150.9 pg/mL interquartile range (IQR) 77.8–260.7 to 316.2 pg/mL IQR 197.5–466.8; p < 0.001), accompanied by a significant decrease in aldosterone (5.5 ng/dL IQR 3.0–8.7 to 2.5 ng/dL IQR 1.4–3.4; p < 0.001). Moreover, LAAC was associated with a marked reduction in systolic (127.3 ± 12.3 mmHg to 116.9 ± 12.4 mmHg; p < 0.001) and diastolic (80.7 ± 7.7 mmHg to 67.4 ± 9.3 mmHg; p < 0.001) blood pressure. Significant decreases in serum sodium and increases in serum potassium were also noted. A significant reduction in the use of angiotensin converting enzyme inhibitor (ACEI)/angiotensin receptor blocker (ARB) and calcium channel blocker (CCB) antihypertensive agents was observed postoperatively. No significant changes in cardiac structure or function were detected. The decrease in blood pressure persisted at 6-month follow-up. Conclusions: LAAC-induced hypotension may be partly mediated by BNP-driven suppression of aldosterone, thereby promoting natriuresis and reduced blood volume. These findings highlight the need for postoperative hemodynamic monitoring and antihypertensive medication adjustment in AF patients who undergo LAAC.
Yao et al. (Fri,) conducted a observational in Atrial Fibrillation (n=99). Left atrial appendage clipping (LAAC) vs. Pre-operative baseline was evaluated on Systolic blood pressure (mmHg) (p=<0.001). Left atrial appendage clipping significantly reduced mean systolic blood pressure from 127.3 mmHg to 116.9 mmHg, an effect potentially mediated by increased B-type natriuretic peptide.
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