Mohit K Turagam1, Venkat Vuddanda2, Niels Verberkmoes3, Toshiya Ohtsuka4, Ferdi Akca3, Donita Atkins5, Sudharani Bommana5, Maximilian Y Emmert6, Rakesh Gopinathannair7, Gansevoort Dunnington8, Abdi Rasekh9, Jie Cheng10, Sacha Salzberg11, Andrea Natale12, James Cox13, Dhanunjaya R Lakkireddy14. 1. Department of Cardiology, Icahn School of Medicine at Mount Sinai, New York, New York. 2. Harvard Medical School, Boston, Massachusetts. 3. Heart Center, Catharina Hospital, Eindhoven, the Netherlands. 4. Department of Cardiovascular Surgery, Tokyo Metropolitan Tama Medical Center, Tokyo, Japan. 5. Kansas City Heart Rhythm Institute & Research Foundation, Overland Park, Kansas. 6. Clinic for Cardiovascular Surgery, University Hospital, Zurich, Switzerland. 7. Division of Cardiovascular Medicine, University of Louisville, Louisville, Kentucky. 8. St. Helena Hospital, St. Helena, California. 9. Baylor College of Medicine, Houston, Texas. 10. Texas Heart Institute, Houston, Texas. 11. HeartClinic, Hirslanden Hospital, Zurich, Switzerland. 12. Texas Cardiac Arrhythmia Institute, Austin, Texas. Electronic address: https://twitter.com/andreanatalemd. 13. Feinberg School of Medicine, Northwestern University, Chicago, Illinois. 14. Kansas City Heart Rhythm Institute & Research Foundation, Overland Park, Kansas. Electronic address: dlakkireddy@kchri.org.
Abstract
BACKGROUND: Percutaneous left atrial appendage exclusion (LAAE) has evolved as an alternative strategy for stroke prevention in atrial fibrillation (AF). Recent observational data have suggested that epicardial LAAE can have substantial impact on arrhythmia burden and hemodynamic profile. OBJECTIVES: The authors aimed to study the impact of epicardial versus endocardial LAAE on systemic blood pressure in hypertensive AF patients. METHODS: This was a prospective, nonrandomized study comparing 247 patients who underwent epicardial LAAE with 124 patients with endocardial exclusion. Clinical outcomes were measured at 3 months and 1 year. Primary outcome was improvement in systolic blood pressure (SBP) between both groups compared with baseline. Secondary outcome included changes in diastolic pressures (DBP), serum electrolytes, and creatinine. RESULTS: There was no significant difference in baseline SBP between epicardial and endocardial groups. SBP was significantly lower in the epicardial group both at 3 months (122 ± 11.8 mm Hg vs. 129.7 ± 8.2 mm Hg; p < 0.001) and 1 year (123 ± 11.6 mm Hg vs. 132.2 ± 8.8 mm Hg; p < 0.001) compared with the endocardial group. An adjusted multivariate linear mixed effects model demonstrated that epicardial LAAE significantly decreased SBP by 7.4 mm Hg at 3 months and by 8.9 mm Hg at 1 year (p < 0.0001). There was a trend toward lower DBP with epicardial LAAE at 3 months by 1.3 mm Hg (p = 0.2) and at 1 year by 1.8 mm Hg (p = 0.09). There was no significant difference in serum electrolytes and creatinine between both groups. CONCLUSIONS: In hypertensive AF patients, epicardial LAAE significantly decreases SBP both at 3 and 12 months compared with endocardial exclusion.
BACKGROUND: Percutaneous left atrial appendage exclusion (LAAE) has evolved as an alternative strategy for stroke prevention in atrial fibrillation (AF). Recent observational data have suggested that epicardial LAAE can have substantial impact on arrhythmia burden and hemodynamic profile. OBJECTIVES: The authors aimed to study the impact of epicardial versus endocardial LAAE on systemic blood pressure in hypertensiveAFpatients. METHODS: This was a prospective, nonrandomized study comparing 247 patients who underwent epicardial LAAE with 124 patients with endocardial exclusion. Clinical outcomes were measured at 3 months and 1 year. Primary outcome was improvement in systolic blood pressure (SBP) between both groups compared with baseline. Secondary outcome included changes in diastolic pressures (DBP), serum electrolytes, and creatinine. RESULTS: There was no significant difference in baseline SBP between epicardial and endocardial groups. SBP was significantly lower in the epicardial group both at 3 months (122 ± 11.8 mm Hg vs. 129.7 ± 8.2 mm Hg; p < 0.001) and 1 year (123 ± 11.6 mm Hg vs. 132.2 ± 8.8 mm Hg; p < 0.001) compared with the endocardial group. An adjusted multivariate linear mixed effects model demonstrated that epicardial LAAE significantly decreased SBP by 7.4 mm Hg at 3 months and by 8.9 mm Hg at 1 year (p < 0.0001). There was a trend toward lower DBP with epicardial LAAE at 3 months by 1.3 mm Hg (p = 0.2) and at 1 year by 1.8 mm Hg (p = 0.09). There was no significant difference in serum electrolytes and creatinine between both groups. CONCLUSIONS: In hypertensiveAFpatients, epicardial LAAE significantly decreases SBP both at 3 and 12 months compared with endocardial exclusion.
Authors: Daniel Ho; William Schierding; Sophie L Farrow; Antony A Cooper; Andreas W Kempa-Liehr; Justin M O'Sullivan Journal: Front Genet Date: 2022-01-03 Impact factor: 4.599
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