Left atrial enlargement and clinical considerations in patients with or without a residual interatrial shunt after closure of the left atrial appendage with the WATCHMAN™-device

• Published in: BMC cardiovascular disorders 2017-12, Vol.17 (1), p.294-294, Article 294
• Main Authors: Luani, Blerim, Groscheck, Thomas, Genz, Conrad, Tanev, Ivan, Rauwolf, Thomas, Herold, Joerg, Medunjanin, Senad, Schmeisser, Alexander, Braun-Dullaeus, Rüdiger C
• Format: Article
• Language: English
• Subjects: 3D transthoracic echocardiography; Aged; Aged, 80 and over; Anticoagulants (Medicine); Atrial Appendage - diagnostic imaging; Atrial Appendage - physiopathology; Atrial fibrillation; Atrial Fibrillation - diagnostic imaging; Atrial Fibrillation - physiopathology; Atrial Fibrillation - therapy; Atrial Remodeling; Biomarkers - blood; Cardiac Catheterization - adverse effects; Cardiac Catheterization - instrumentation; Care and treatment; Device related thrombi; Echocardiography, Three-Dimensional; Echocardiography, Transesophageal; Exercise Tolerance; Female; Health aspects; Heart; Hemodynamics; Humans; Interatrial shunt; LAA closure; Left atrial volume; Male; Natriuretic Peptide, Brain - blood; Peptide Fragments - blood; Prognosis; Prospective Studies; Recovery of Function; Stroke Volume; Thromboembolism; Time Factors; Treatment Outcome; Ventricular Function, Left; Walk Test; Watchman device
• ISSN: 1471-2261; 1471-2261
• DOI: 10.1186/s12872-017-0728-6

Interventional closure of the left atrial appendage (LAA) in patients with non-valvular atrial fibrillation, high thromboembolic and bleeding risk or bleeding history is an alternative therapeutic strategy to oral anticoagulation. It is not known if the exclusion of the LAA from the blood circulation affects the left atrial volume (LAV) and consequently its prognostic value or the circulatory performance of the heart in humans. We aimed to prospectively assess potential changes in baseline LAV, left ventricular ejection fraction (LVEF), NT-proBNP-level and the covered distance in the 6-min walk-test 6 weeks and 6 months after LAA closure with the WATCHMAN™ device. We used serial 3-dimensional transthoracic and transesophageal echocardiography to assess LAV, residual interatrial shunt and device performance in 58 consecutive patients with successful LAA closure. Accurate 3D-echocardiographic data for LAV measurements were evaluable for 51 (91%) patients. Maximum LAV (LAVmax) at baseline was 102.8 ± 30.8 ml and increased significantly to 107.7 ± 32.8 ml after 6 weeks (p