Impact of left atrial appendage closure on cardiac functional and structural remodeling: A difference-in-difference analysis of propensity score matched samples

Phan, Quang Tan; Shin, Seung Yong; Cho, Ik Sung; Lee, Wang Soo; Won, Hoyoun; Sharmin, Saima; Lee, Dong Hoon; Kim, Tae Ho; Kim, Chee Jeong; Kim, Sang Wook

doi:10.5603/cj.a2018.0047

Cited by 20 publications

(24 citation statements)

References 36 publications

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“…Previous literature reported opposite effects on left atrial volume changes between AF ablation and LAAC, [ 25 , 26 ] that AF ablation led to decreased left atrial volume (reverse remodeling) [ 25 ] while LAAC induced left atrial enlargement (remodeling). [ 26 ] Therefore, LAAC with concomitant ablation might benefit patients by reversing LAAC-induced left atrial remodeling, which was supported by our previous study using cardiac CT-based evaluation. [ 27 ] However, the reverse remodeling has not been detected by the TTE follow-up in the present study.…”

Section: Discussionmentioning

confidence: 99%

One-stop strategy for treatment of atrial fibrillation: feasibility and safety of combining catheter ablation and left atrial appendage closure in a single procedure

Chen

Wang

et al. 2020

Chinese Medical Journal

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Background Catheter ablation is effective in restoring sinus rhythm and left atrial appendage closure (LAAC) is increasingly used for stroke prevention in patients with atrial fibrillation (AF). We aimed to observe the feasibility and safety of performing AF ablation and LAAC in a single (one-stop) procedure. Methods Consecutive AF patients who underwent the combined procedure of AF ablation and LAAC with WATCHMAN device between March 2017 and September 2018 were prospectively enrolled. Baseline and intra-procedural parameters were evaluated. Three-month and subsequent 1-year follow-up were performed in all and earlier-enrolled subjects, respectively. Results A total of 178 AF patients (94 males, 68.9 ± 8.1 years) underwent the one-stop procedure with CHA 2 DS 2 -VASc score 3.3 ± 1.5 and HAS-BLED score 1.6 ± 1.0, respectively. Pulmonary vein isolation was achieved in all patients while additional linear ablation was applied if the operator deemed necessary, yielding immediate ablation success rate of 98.9% (176/178). In the subsequent LAAC, satisfactory seal (residual leak <5 mm) was achieved in all patients. One stroke and four cardiac perforations occurred peri-operatively. At 3-month follow-up, sinus rhythm and satisfactory seal were maintained in 153/178 (86.0%) and 178/178 (100%) patients, respectively. One stroke and one delayed cardiac tamponade occurred, while no device-related thrombus or device migration was observed. During the 1-year follow-up for the earlier enrolled subjects, 52/72 (72.2%) of the patients maintained sinus rhythm. There was no stroke or systemic embolism observed. Conclusion Combining catheter ablation and LAAC in a single procedure can be successfully and safely performed in non-valvular AF patients of Chinese population.

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Section: Discussionmentioning

confidence: 99%

One-stop strategy for treatment of atrial fibrillation: feasibility and safety of combining catheter ablation and left atrial appendage closure in a single procedure

Chen

Wang

et al. 2020

Chinese Medical Journal

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“…Patients with significant LA structural reverse remodeling following AFCA have better LA function, and may indicate more efficient LV filling pattern and better cardiac function . On the other hand, latest studies have shown a significantly increased LAV after LAAC . It was also pointed out that the LA enlargement was unlikely to be caused by structural remodeling due to AF, as AF load did not significantly increase during follow‐up .…”

Section: Discussionmentioning

confidence: 99%

“…Patients studies have shown a significantly increased LAV after LAAC. 8,9 It was also pointed out that the LA enlargement was unlikely to be caused by structural remodeling due to AF, as AF load did not significantly increase during follow-up. 8 It is thus evident that AFCA and LAAC exert opposite effects on LA size, with the former resulting in LA structural reverse remodeling while the latter exacerbating the remodeling process.…”

Section: Simple Linear Regression Analysismentioning

confidence: 99%

“…Results from a number of studies showed that LA volume (LAV) was significantly decreased after successful catheter ablation of AF (AFCA) . In contrast, recent studies have found a significant increase in LAV after left atrial appendage closure (LAAC), which might be linked with the reduced LA compliance after the closure of LAA. The impact of combined AFCA and LAAC on LAV remains largely unknown till date.…”

Section: Introductionmentioning

confidence: 99%

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Determinants of postoperative left atrial structural reverse remodeling in patients undergoing combined catheter ablation of atrial fibrillation and left atrial appendage closure procedure

Gong

Zhao

et al. 2019

Cardiovasc electrophysiol

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Introduction Catheter ablation of atrial fibrillation (AFCA) and left atrial appendage closure (LAAC) exert opposite effects on left atrial (LA) size. We aim to observe the net impact of combined AFCA and LAAC strategy on LA size and explore those factors which might affect the postprocedure LA structural remodeling. Methods A total of 53 patients, who underwent combined AFCA and Watchman LAAC in our center from March to December 2017, were enrolled. Atrial fibrillation (AF) recurrence was monitored after the procedure. Left atrial volume (LAV) and left atrial appendage volume (LAAV) were measured by Mimics based on dual‐source computed tomography images. Results At 6 months, sinus rhythm (SR) was maintained in 79.2% patients. LAV was significantly reduced (130.2 ± 36.3 mL to 107.1 ± 30.0 ml; P < .001) in SR maintenance group, but not in AF recurrence group (138.8 ± 39.3 mL to 137.9 ± 36.9 mL; P = .671). In SR group, preoperative LAAV/LAV ratio (B = −0.894; P = .015), NT‐proBNP (B = 0.005; P = .019) and left ventricular ejection fraction (LVEF) (B = −0.778; P < .001) could interactively affect the extent of postoperative LA structural reverse remodeling, among which LAAV/LAV ratio could independently predict the significance of reverse remodeling (≥15% reduction in LAV) (OR, 0.56; 95% CI, 0.34‐0.90; P = .018). A preoperative LAAV/LAV ratio less than 7.1% is indicative of significant LA structural reverse remodeling in this patient cohort. Conclusions LA structural reverse remodeling could be evidenced in patients with maintained SR following combined AFCA and LAAC. Smaller LAAV/LAV ratio, higher NT‐proBNP or lower LVEF at baseline are associated with more significant LA structural reverse remodeling, while LAAV/LAV ratio can predict the significance of the process after one‐stop treatment.

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“…Also, LAAO induced left atrium size increasing and left ventricular filling pressure need further study. 80) …”

Section: Left Atrial Appendage Occlusion In Asian Populationsmentioning

confidence: 99%

Stroke Prevention in Atrial Fibrillation: Focus on Asian Patients

Lee

Choi

et al. 2018

Korean Circ J

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Atrial fibrillation (AF) is the most common arrhythmia conferring a fivefold increased risk of stroke. Stroke prevention is the cornerstone of management of patients with AF. Asians have a generally higher incidence of AF-related risks of stroke and bleeding (particularly intracranial bleeding), compared with non-Asians. Despite the well-documented efficacy and relative safety of oral anticoagulation for stroke prevention among Asians, the suboptimal use of oral anticoagulation remains common. The current narrative review aims to provide a summary of the available evidence on stroke prevention among patients with AF focused on the Asia region, regarding stroke and bleeding risk evaluation, the performance of oral anticoagulation, and current use of thromboprophylaxis.

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Impact of left atrial appendage closure on cardiac functional and structural remodeling: A difference-in-difference analysis of propensity score matched samples

Abstract: Background: Although the safety and efficacy of left atrial appendage (LAA) closure (LAAC) in

Cited by 20 publications

References 36 publications

One-stop strategy for treatment of atrial fibrillation: feasibility and safety of combining catheter ablation and left atrial appendage closure in a single procedure

One-stop strategy for treatment of atrial fibrillation: feasibility and safety of combining catheter ablation and left atrial appendage closure in a single procedure

Determinants of postoperative left atrial structural reverse remodeling in patients undergoing combined catheter ablation of atrial fibrillation and left atrial appendage closure procedure

Stroke Prevention in Atrial Fibrillation: Focus on Asian Patients

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