Evaluation of left atrial remodelling following percutaneous left atrial appendage closure

Objectives The left atrial appendage (LAA) is known to play a reservoir role in left atrial (LA) hemodynamics. The physiologic consequences of its percutaneous occlusion have not been evaluated. We sought to evaluate the effect of percutaneous LA appendage closure (LAAC) on LA remodelling and cardiac hemodynamics. Methods: All patients referred for LAAC in our institution were enrolled. Cardiac computed tomography for LA volume measurement and transthoracic echocardiography (TTE) for left ventricular diastolic function and filling pressure assessment were performed at baseline and 3 months after closure. Results: Sixty-three patients (mean age 73 ? 9 years) underwent successful LAAC and remain clinically stable at 3 months without change in medical treatment except the introduction of an antiplatelet therapy. Mean LA volume, excluding the LAA did not change between baseline and follow-up (145 55 mL and 144 50 mL, p=0.30). Among diastolic function echographic parameters, the E/E’ ratio increased (7.9?2.1 vs 9.1?3.6; p=0,038), suggesting a trend toward an elevation of LV filling pressure. Conclusions: In this preliminary study, we showed no early significant LA remodelling after LAA occlusion in terms of volume change, but a trend toward an increase of LV filling pressure. Our results suggest potential changes in cardiac hemodynamics after LAA closure, suggesting to be cautious when performing this procedure in patients with heart failure. Additional studies with longer follow-up and invasive evaluations should be performed to better investigate this potential issue.