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Electrolyte and hemodynamic changes following percutaneous left atrial appendage ligation with the LARIAT device

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Abstract

Purpose

The left atrial appendage (LAA) is a well-known source of atrial natriuretic peptide (ANP) and therefore plays an important role in homeostasis. The neurohormonal impact of epicardial exclusion of the LAA with the LARIAT procedure is unknown. In this proof-of-concept study, we postulated that LAA exclusion would impact homeostasis as evidenced by changes in electrolytes and blood pressure (BP).

Methods

A total of 76 patients who underwent successful LAA exclusion were enrolled in this retrospective observational study utilizing a prospective registry. Electrolytes, BP, and heart rate (HR) were monitored before LARIAT and post-LARIAT (24 and 72 h and 6 months).

Results

There was a significant reduction of systolic BP (mmHg) at 24 h (113.3 ± 16.0; p < 0.0001) and 72 h (119.0 ± 18.4 mmHg; p < 0.0001) post-LARIAT when compared with pre-LARIAT BP (138.2 ± 21.3). The reduction in systolic BP persisted at 6-month follow-up (128.8 ± 17.3; p = 0.0005). There was significant reduction in serum sodium (mmol/L) at 24 h (135.4 ± 3.6; p < 0.0001) and 72 h (136.3 ± 3.7; p < 0.001) post-LARIAT when compared to pre-LARIAT (138.7 ± 3.2). The reduction in sodium was not persistent at 6-month follow-up (138.4 ± 3.3; p = 0.453).

Conclusions

LAA exclusion results in an early and persistent decrease in systolic BP. Additionally, there is an early decline in serum sodium, which normalizes at long-term follow-up. The underlying mechanism leading to these changes is not entirely clear; however, it is likely related to neurohormonal changes post LAA exclusion.

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References

  1. Sadler, T. W., & Langman, J. (2004). Langman’s medical embryology (Vol. v. 1). Baltimore: Lippincott Williams & Wilkins.

    Google Scholar 

  2. Fang, M. C., Stafford, R. S., Ruskin, J. N., & Singer, D. E. (2004). National trends in antiarrhythmic and antithrombotic medication use in atrial fibrillation. Archives of Internal Medicine, 164(1), 55–60.

    Article  PubMed  Google Scholar 

  3. Desai, N. R., Krumme, A. A., Schneeweiss, S., Shrank, W. H., Brill, G., Pezalla, E. J., et al. (2014). Patterns of initiation of oral anticoagulants in patients with atrial fibrillation—quality and cost implications. American Journal of Medicine.

  4. Massumi, A., Chelu, M. G., Nazeri, A., May, S. A., Afshar-Kharaghan, H., Saeed, M., et al. (2013). Initial experience with a novel percutaneous left atrial appendage exclusion device in patients with atrial fibrillation, increased stroke risk, and contraindications to anticoagulation. American Journal of Cardiology, 111(6), 869–873.

    Article  PubMed  Google Scholar 

  5. Bartus, K., Han, F. T., Bednarek, J., Myc, J., Kapelak, B., Sadowski, J., et al. (2013). Percutaneous left atrial appendage suture ligation using the LARIAT device in patients with atrial fibrillation: initial clinical experience. Journal of the American College of Cardiology, 62(2), 108–118.

    Article  PubMed  Google Scholar 

  6. Bartus, K., Bednarek, J., Myc, J., Kapelak, B., Sadowski, J., Lelakowski, J., et al. (2011). Feasibility of closed-chest ligation of the left atrial appendage in humans. Heart Rhythm, 8(2), 188–193.

    Article  PubMed  Google Scholar 

  7. Han, F. T., Bartus, K., Lakkireddy, D., Rojas, F., Bednarek, J., Kapelak, B., et al. (2014). The effects of LAA ligation on LAA electrical activity. Heart Rhythm, 11(5), 864–870.

    Article  PubMed  Google Scholar 

  8. Yoshihara, F., Nishikimi, T., Kosakai, Y., Isobe, F., Matsuoka, H., Takishita, S., et al. (1998). Atrial natriuretic peptide secretion and body fluid balance after bilateral atrial appendectomy by the maze procedure. Journal of Thoracic and Cardiovascular Surgery, 116(2), 213–219.

    Article  CAS  PubMed  Google Scholar 

  9. Nakamura, M., Niinuma, H., Chiba, M., Ueshima, K., Arakawa, N., Yagi, Y., et al. (1997). Effect of the maze procedure for atrial fibrillation on atrial and brain natriuretic peptide. American Journal of Cardiology, 79(7), 966–970.

    Article  CAS  PubMed  Google Scholar 

  10. Hocini, M., Shah, A. J., Nault, I., Sanders, P., Wright, M., Narayan, S. M., et al. (2011). Localized reentry within the left atrial appendage: arrhythmogenic role in patients undergoing ablation of persistent atrial fibrillation. Heart Rhythm, 8(12), 1853–1861.

    Article  PubMed Central  PubMed  Google Scholar 

  11. Kamohara, K., Popović, Z. B., Daimon, M., Martin, M., Ootaki, Y., Akiyama, M., et al. Impact of left atrial appendage exclusion on left atrial function. Journal of Thoracic and Cardiovascular Surgery, 133(1), 174–181.

  12. Khattab, A. A., & Meier, B. (2010). Transcatheter left atrial appendage exclusion, gold or fool’s gold? European Heart Journal Supplements, 12(suppl E), E35–E40.

    Article  Google Scholar 

  13. Al-Saady, N. M., Obel, O. A., & Camm, A. J. (1999). Left atrial appendage: structure, function, and role in thromboembolism. Heart, 82(5), 547–554.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  14. de Bold, A. J., Bruneau, B. G., & Kuroski de Bold, M. L. (1996). Mechanical and neuroendocrine regulation of the endocrine heart. Cardiovascular Research, 31(1), 7–18.

    Article  PubMed  Google Scholar 

  15. Saito, Y. (2010). Roles of atrial natriuretic peptide and its therapeutic use. Journal of Cardiology, 56(3), 262–270.

    Article  PubMed  Google Scholar 

  16. Tabata, T., Oki, T., Yamada, H., Abe, M., Onose, Y., & Thomas, J. D. (2000). Relationship between left atrial appendage function and plasma concentration of atrial natriuretic peptide. European Journal of Echocardiography, 1(2), 130–137.

    Article  CAS  PubMed  Google Scholar 

  17. Sakellaridis, T., Argiriou, M., Charitos, C., Tsakiridis, K., Zarogoulidis, P., Katsikogiannis, N., et al. (2014). Left atrial appendage exclusion-where do we stand? Journal of Thoracic Diseases, 6(Suppl 1), S70–S77.

    Google Scholar 

  18. Ramnarain, D., & Mehra, N. (2011). Natriuretic peptide-induced hyponatremia in a patient with left atrial myxoma. Critical Care, 15(1), 1–190.

    Article  Google Scholar 

  19. Hannon, M. J., Behan, L. A., O’Brien, M. M., Tormey, W., Ball, S. G., Javadpur, M., et al. (2014). Hyponatremia following mild/moderate subarachnoid hemorrhage is due to SIAD and glucocorticoid deficiency and not cerebral salt wasting. Journal of Clinical Endocrinology and Metabolism, 99(1), 291–298.

    Article  CAS  PubMed  Google Scholar 

  20. Cesar, K. R., & Magaldi, A. J. (1999). Thiazide induces water absorption in the inner medullary collecting duct of normal and Brattleboro rats. American Journal of Physiology, 277(5 Pt 2), F756–F760.

    CAS  PubMed  Google Scholar 

  21. Potter, L. R. (2011). Natriuretic peptide metabolism, clearance and degradation. FEBS Journal, 278(11), 1808–1817.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  22. Di Biase, L., Burkhardt, J. D., Mohanty, P., Sanchez, J., Mohanty, S., Horton, R., et al. (2010). Left atrial appendage: an underrecognized trigger site of atrial fibrillation. Circulation, 122(2), 109–118.

    Article  PubMed  Google Scholar 

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Conflicts of interest

Dhanunjaya Lakkireddy has received an unrestricted research grant from SentreHEART, Inc., Biosense Webster Inc, and SJM and speakers honorarium from Boehringer Ingelheim, Biotronik, Janssen, and Pfizer and is a consultant to BWI, SentreHEART, Inc. and SJM.

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Correspondence to Dhanunjaya Lakkireddy.

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Maybrook, R., Pillarisetti, J., Yarlagadda, V. et al. Electrolyte and hemodynamic changes following percutaneous left atrial appendage ligation with the LARIAT device. J Interv Card Electrophysiol 43, 245–251 (2015). https://doi.org/10.1007/s10840-015-0012-6

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  • DOI: https://doi.org/10.1007/s10840-015-0012-6

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