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. 2022 Mar 9;11(6):1495.
doi: 10.3390/jcm11061495.

Long Term Impact of Epicardial Left Atrial Appendage Ligation on Systemic Hemostasis: LAA HOMEOSTASIS-2

Krzysztof Bartus  1   2 , Sri Harsha Kanuri  3 , Radoslaw Litwinowicz  1   2 , Mehmet Ali Elbey  3 , Joanna Natorska  2 , Michal Zabczyk  2 , Magdalena Bartus  4 , Boguslaw Kapelak  1   2 , Rakesh Gopinnathannair  3 , Jalaj Garg  5 , Mohit K Turagam  6 , Maciej T Malecki  7 , Randall J Lee  8 , Dhanunjaya Lakkireddy  3
Affiliations

Long Term Impact of Epicardial Left Atrial Appendage Ligation on Systemic Hemostasis: LAA HOMEOSTASIS-2

Krzysztof Bartus et al. J Clin Med. .

Abstract

Background: Recent data suggest that epicardial left atrial appendage closure (LAAC) is associated with several short-term neurohormonal effects. However, the long-term effects are currently unknown.

Objective: To investigate the effects of percutaneous epicardial left atial appendage (LAA) exclusion using LARIAT on neurohormonal profiles at long-term follow-up.

Methods: In a prospective single centre study, 60 patients with long-standing, persistent atrial fibrillation (AF) LARIAT were treated. The major hormones of the adrenergic system, renin-angiotensin-aldosterone system (RAAS), and natriuretic peptides were assessed before the intervention and at regular intervals during the following two years.

Results: In patients with epicardial LAAC, atrial natriuretic peptide (ANP) levels were significantly increased from baseline at 24 h and decreased at 7 days, 1 month, and 3 months, while remaining unchanged at 12 and 24 months. Noradrenaline levels were significantly lower at 24 h, 7 days, 1 month, 6 months, 12 months, and 24 months, while epinephrine levels decreased significantly at 1 month, 6 months, 12 months, and 24 months. Plasma renin activity significantly decreased at 7 days, 1 month, 6 months, 12 months, and 24 months, while aldosterone levels significantly decreased at 6 months, 12 months, and 24 months. Endothelin-1 and vasopressin showed a significant increase and decrease, respectively, at 24 h, 7 days, 1 month, 6 months, 12 months, and 24 months. There was also a significant decrease in systolic and diastolic blood pressure at 3 months, 6 months, 1 year, and 2 years after the intervention.

Conclusions: Epicardial LAAC in AF patients is associated with persistent neurohormonal changes favouring blood pressure reduction.

Keywords: LARIAT; blood pressure (BP); left atrial appendage closure (LAAC); neurohormonal changes; systemic hemostasis.

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Conflict of interest statement

K.B. and his institutions Jagiellonian University Medical College and John Paul II Hospital in Krakow Poland were recipients of the research grants from the Polish National Science Centre. R.J.L. is a part-time Medical Director of Atricure. Other authors declare no conflict of interest concerning this study.

Figures

Figure 1
Figure 1
In a 2-year follow-up after LAAO procedure, mean SBP and DBP in our study is (119.4 ± 4.8 mmHg) and (73.2 ± 3.7 mmHg), respectively.
See this image and copyright information in PMC

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