Author + information
- Antonious Attallah,
- Prasanth Lingam,
- Joseph Chattahi,
- Janet Wyman,
- Adam Greenbaum,
- William O'Neill and
- Mayra Guerrero
Percutaneous left atrial appendage (LAA) closure has recently emerged as a new therapeutic option for stroke prevention in atrial fibrillation patients at high risk of embolic events, who are not candidates for anticoagulation therapy. The LARIAT© Suture Delivery Device (SentreHeart, Redwood, CA, USA) is an FDA approved method of obtaining such closure. The effect of LAA suture on B–type natriuretic peptide (BNP) release or cardiac biomarker levels suggestive of LAA tissue necrosis, is not known.
From June 2012 to October 2012, ten patients underwent percutaneous LAA suture with the LARIAT device at our institution. Cardiac Troponin I (cTNI), B–type Natriuretic Peptide (BNP), as well as Creatinine Kinase–MB (CK–MB) were assessed pre and post procedure.
Of the 10 patients reviewed, ten had a complete set of pre and post–procedural values for cTNI, four had CK–MB levels, and 4 had BNP levels. Compared to baseline cTNI (median= 0.04 ± 0.13 ng/ml), there was an increase in post–procedural levels (median= 1.54 ± 0.88 ng/ml) with a median time to peak of 26.5 ± 10 hours post–procedure. An increase was also noted in CK–MB levels (baseline= 2.2 ± 1.47 ng/ml vs post–procedure= 4.6 ± 3.2 ng/ml) with a median time to peak of 17 ± 10 hours. Similarly, BNP levels increased from a median baseline of 74.5 ± 544 pg/ml to 242 ± 614 pg/ml, with a median time to peak of 6.5 ± 8 hours post–procedure. There was no evidence of peri–procedural coronary events in any of the patients, ECG changes or new wall motion abnormalities by echocardiogram.
Percutaneous left atrial appendage suture with the LARIAT© device appears to be associated with an increase in the levels of cTNI, CK–MB, and BNP in the acute phase (24 to 48 hours). We suspect that the post–procedural increase in injury biomarkers likely reflect LAA tissue necrosis and not a peri–procedural coronary event. The clinical significance of these findings is unknown. Further studies in a larger number of patients with longer follow up are needed.
Poster Sessions, Expo North
Monday, March 11, 2013, 9:45 a.m.–10:30 a.m.
Session Title: Structural Heart Disease Intervention
Abstract Category: 51. TCT@ACC–i2: Non–valvular Structural Heart Disease
Presentation Number: 2114–253
- 2013 American College of Cardiology Foundation