A MULTICENTRE study has shown that left atrial appendage closure (LAAC) is associated with acute increases in left atrial pressure (LAP) during and immediately after the procedure, although no adverse structural or biomarker changes were observed during short-term follow-up. The findings provide new insights into the haemodynamic impact of LAAC, a procedure increasingly used to reduce stroke risk in patients with atrial fibrillation who are unsuitable for long-term anticoagulation.
The study assessed both acute haemodynamic responses and short-term echocardiographic and biomarker outcomes following LAAC. The left atrial appendage plays a recognised role in atrial reservoir function and endocrine regulation, prompting interest in how its occlusion may affect cardiac physiology.
The investigators enrolled 62 patients across two centres between January 2022 and July 2024. The cohort had a mean age of 75.7 years, with 72.6% male, and a mean CHA₂DS₂-VASc score of 4.1, reflecting a population at high thromboembolic risk. Invasive LAP measurements were taken immediately after transseptal puncture and following device deployment, both at rest and after isometric exercise.
Hemodynamic Changes Observed After Left Atrial Appendage Closure
Results showed that LAP increased significantly after device implantation. At rest, mean LAP rose from 14.9±7.1 mmHg before closure to 17.6±7.9 mmHg after (p<0.001). Post-exercise LAP also increased, from 18.7±8.6 mmHg to 21.8±9.5 mmHg (p<0.001). These findings indicate an acute haemodynamic response to LAAC during both resting and exertional states.
Importantly, the study identified procedural fluid administration as a key factor influencing pressure changes. Larger volumes of fluid given during the procedure were significantly associated with greater increases in resting LAP after device deployment. Conversely, exercise-induced changes in LAP following the procedure were negatively associated with the amount of fluid administered, highlighting the complex interplay between volume loading and atrial pressure dynamics.
Considerations in Interpreting Left Atrial Appendage Closure Findings
Despite these acute effects, no significant changes were observed in heart failure biomarkers, including NT-proBNP, NT-proANP, and GDF-15, at 3-month follow-up. Similarly, echocardiographic assessments at 6 months showed no significant changes in left atrial or left ventricular structure or function.
The authors conclude that while LAAC causes a measurable acute increase in LAP, this does not appear to translate into adverse short-term biochemical or structural cardiac changes. They emphasise the importance of careful fluid management during LAAC procedures and call for further studies to assess longer-term clinical implications.
Reference
Herman D et al. Acute and Short-Term Hemodynamic and Echocardiography Changes During and After Left Atrial Appendage Closure. J Interv Cardiol. 2025;doi: 10.1155/joic/5515180
