Author + information
- Received June 11, 2018
- Accepted June 22, 2018
- Published online September 10, 2018.
- Mohit K. Turagam, MDa,
- Venkat Vuddanda, MDb,
- Niels Verberkmoes, MDc,
- Toshiya Ohtsuka, MDd,
- Ferdi Akca, MDc,
- Donita Atkins, RNe,
- Sudharani Bommana, MSce,
- Maxillian Y. Emmert, MDf,
- Rakesh Gopinathannair, MD, MAg,
- Gansevoort Dunnington, MDh,
- Abdi Rasekh, MDi,
- Jie Cheng, MDj,
- Sacha Salzberg, MDk,
- Andrea Natale, MDl@andreanatalemd,
- James Cox, MDm and
- Dhanunjaya R. Lakkireddy, MDe,∗ (, )@DJ_Lakkireddy@OPRMC
- aDepartment of Cardiology, Icahn School of Medicine at Mount Sinai, New York, New York
- bHarvard Medical School, Boston, Massachusetts
- cHeart Center, Catharina Hospital, Eindhoven, the Netherlands
- dDepartment of Cardiovascular Surgery, Tokyo Metropolitan Tama Medical Center, Tokyo, Japan
- eKansas City Heart Rhythm Institute & Research Foundation, Overland Park, Kansas
- fClinic for Cardiovascular Surgery, University Hospital, Zurich, Switzerland
- gDivision of Cardiovascular Medicine, University of Louisville, Louisville, Kentucky
- hSt. Helena Hospital, St. Helena, California
- iBaylor College of Medicine, Houston, Texas
- jTexas Heart Institute, Houston, Texas
- kHeartClinic, Hirslanden Hospital, Zurich, Switzerland
- lTexas Cardiac Arrhythmia Institute, Austin, Texas
- mFeinberg School of Medicine, Northwestern University, Chicago, Illinois
- ↵∗Address for correspondence:
Dr. Dhanunjaya Lakkireddy, The Kansas City Heart Rhythm Institute (KCHRI), HCA MidWest, 12200 West 106th street, Overland Park Regional Medical Center, Overland Park, Kansas 66215.
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.
Dr. Verberkmoes has been a consultant for AtriCure. Dr. Emmert has received speaker fees from AtriCure. Dr. Gopinathannair has received research grants and/or honoraria from Pfizer, Bristol-Myers Squibb, Zoll Medical, Abbott Medical, HealthTrust PG, Boston Scientific, and Abiomed. Dr. Dunnington has been a consultant for AtriCure. Dr. Natale has been a consultant for Biosense Webster, Stereotaxis, Abbott, and Boston Scientific; and has received speaker/travel honoraria from Medtronic, AtriCure, EPiEP Biotronik, and Janssen. Dr. Cox has been a consultant for AtriCure and SentreHEART; holds stock in Adagio Medical, AtriCure, and SentreHEART; and is a cofounder of and has served on the board of directors of Adagio Medical. Dr. Lakkireddy is a principal investigator for the aMAZE study sponsored by SentreHEART and the AMULET investigational device exemption trial sponsored by St. Jude Medical/Abbott. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received June 11, 2018.
- Accepted June 22, 2018.
- 2018 American College of Cardiology Foundation
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