PURPOSE OF REVIEW: This review aims to summarize the nonthromboembolic prevention effects of left atrial appendage exclusion (LAAE). RECENT FINDINGS: Left atrial appendage (LAA) secretes multiple hormones; regulates blood volume and pressure; and generates trigger activities. Exclusion of the LAA by different techniques may lead to downstream effects including changes in blood pressure and cardiac performance, improvement of outcome of atrial fibrillation (AF) ablation, and alteration of metabolism. SUMMARY: LAAE procedures not only prevent thromboembolic events in patients with AF, but rather may bring additional benefits or side-effect to patients undergoing LAAE.
References
Rashid HN, Layland J. Modification of the left atrial appendage and its role in stroke risk reduction with nonvalvular atrial fibrillation. Int J Cardiol Heart Vasc 2020; 32:1–8.
Beigel R, Wunderlich NC, Ho SY, et al. The left atrial appendage: anatomy, function, and noninvasive evaluation. JACC Cardiovasc Imaging 2014; 7:1251–1265.
de Bold AJ, Borenstein HB, Veress AT, Sonnenberg H. A rapid and potent natriuretic response to intravenous injection of atrial myocardial extract in rats. Life Sci 1981; 28:89–94.
Ogawa T, de Bold AJ. The heart as an endocrine organ. Endocr Connect 2014; 3:R31–R44.
Clerico A, Giannoni A, Vittorini S, Passino C. Thirty years of the heart as an endocrine organ: physiological role and clinical utility of cardiac natriuretic hormones. Am J Physiol Heart Circ Physiol 2011; 301:H12–H20.
Vargas-Barron J, Saucedo-Orozco H, Sanchez-Mendoza A, et al. Modification of serum natriuretic peptide profile and echocardiographic parameters after surgical left atrial appendage exclusion/resection during mitral valve surgery. Heart Lung Circ 2021; 30:751–757.
Cheng WH, Lugtu IC, Chang SL, et al. Effects of angiotensin receptor-neprilysin inhibitor in arrhythmogenicity following left atrial appendage closure in an animal model. Cardiovasc Drugs Ther 2021; 35:759–768.
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 2015; 43:245–251.
Zhang Z, Yang H, Li Y, et al. The effect of minimally invasive thoracoscopic left atrial appendage excision on cardiac dynamic and endocrine function. Ann Thorac Cardiovasc Surg 2021; 27:49–55.
Lakkireddy D, Turagam M, Afzal MR, et al. Left atrial appendage closure and systemic homeostasis: The LAA HOMEOSTASIS Study. J Am Coll Cardiol 2018; 71:135–144.
Turagam MK, Vuddanda V, Verberkmoes N, et al. Epicardial left atrial appendage exclusion reduces blood pressure in patients with atrial fibrillation and hypertension. J Am Coll Cardiol 2018; 72:1346–1353.
de Lannoy LM, Danser AH, van Kats JP, et al. Renin-angiotensin system components in the interstitial fluid of the isolated perfused rat heart. Local production of angiotensin I. Hypertension 1997; 29:1240–1251.
Heller LJ, Opsahl JA, et al. Myocardial and plasma renin-angiotensinogen dynamics during pressure-induced cardiac hypertrophy. Am J Physiol 1998; 274:R849–R856.
Lindpaintner K, Lu W, Neidermajer N, et al. Selective activation of cardiac angiotensinogen gene expression in postinfarction ventricular remodeling in the rat. J Mol Cell Cardiol 1993; 25:133–143.
Iwai N, Shimoike H, Kinoshita M. Cardiac renin-angiotensin system in the hypertrophied heart. Circulation 1995; 92:2690–2696.
van Kesteren CA, Saris JJ, Dekkers DH, et al. Cultured neonatal rat cardiac myocytes and fibroblasts do not synthesize renin or angiotensinogen: evidence for stretch-induced cardiomyocyte hypertrophy independent of angiotensin II. Cardiovasc Res 1999; 43:148–156.
Danser AH, van Kesteren CA, Bax WA, et al. Prorenin, renin, angiotensinogen, and angiotensin-converting enzyme in normal and failing human hearts. Evidence for renin binding. Circulation 1997; 96:220–226.
Nishimura M, Lupercio-Lopez F, Hsu JC. Left atrial appendage electrical isolation as a target in atrial fibrillation. JACC Clin Electrophysiol 2019; 5:407–416.
Briceño DF, Patel K, Romero J, et al. Beyond pulmonary vein isolation in nonparoxysmal atrial fibrillation: posterior wall, vein of Marshall, coronary sinus, superior vena cava, and left atrial appendage. Card Electrophysiol Clin 2020; 12:219–231.
Romero J, Gabr M, Patel K, et al. Efficacy and safety of left atrial appendage electrical isolation during catheter ablation of atrial fibrillation: an updated meta-analysis. Europace 2021; 23:226–237.
Domínguez H, Madsen CV, Westh ONH, et al. Does left atrial appendage amputation during routine cardiac surgery reduce future atrial fibrillation and stroke? Curr Cardiol Rep 2018; 20:99–105.
Nentwich K, Ene E, Halbfass P, et al. Concomitant epicardial left atrial appendage ligation and left atrial ablation of atrial fibrillation: safety, feasibility and outcome. Indian Pacing Electrophysiol J 2021; 21:75–79.
Starck CT, Steffel J, Emmert MY, et al. Epicardial left atrial appendage clip occlusion also provides the electrical isolation of the left atrial appendage. Interact Cardiovasc Thorac Surg 2012; 15:416–418.
Alipour A, Swaans MJ, van Dijk VF, et al. Ablation for atrial fibrillation combined with left atrial appendage closure. JACC Clin Electrophysiol 2015; 1:486–495.
Liu J, Xia Y, Zhang H, et al. Left atrial appendage closure after cryoballoon ablation in patients with atrial fibrillation. Herz 2021; 46:S82–S88.
Ren Z, Zhang J, Wang S, et al. Two-year outcome from combining cryoballoon ablation and left atrial appendage closure: CLACBAC Study. Front Cardiovasc Med 2021; 7:345–354.
Jiang Y, Li F, Li D, et al. Efficacy and safety of catheter ablation combined with left atrial appendage occlusion for nonvalvular atrial fibrillation: A systematic review and meta-analysis. Pacing Clin Electrophysiol 2020; 43:123–132.
Wintgens L, Romanov A, Phillips K, et al. Combined atrial fibrillation ablation and left atrial appendage closure: long-term follow-up from a large multicentre registry. Europace 2018; 20:1783–1789.
Reinthaler M, Grosshauser J, Schmidt T, et al. Preclinical assessment of a modified Occlutech left atrial appendage closure device in a porcine model. Sci Rep 2021; 11:2988–2999.
Schwartz RS, Holmes DR, Van Tassel RA, et al. Left atrial appendage obliteration: mechanisms of healing and intracardiac integration. JACC Cardiovasc Interv 2010; 3:870–877.
Lellouche N, Arrouasse R, Ternacle J, et al. Atrial fibrillation evolution and rhythm control strategy following left appendage closure: new insights from the prospective FLAAC registry. BMC Cardiovasc Disord 2021; 21:227–235.
DeSimone CV, Prakriti BG, Tri J, et al. A review of the relevant embryology, pathohistology, and anatomy of the left atrial appendage for the invasive cardiac electrophysiologist. J Atr Fibrillation 2015; 8:81–87.
Murtaza G, Vuddanda V, Akella K, et al. Impact of left atrial appendage occlusion on left atrial function-The LAFIT Watchman study. J Interv Card Electrophysiol 2020; 58:163–167.
Kamohara K, Popović ZB, Daimon M, et al. Impact of left atrial appendage exclusion on left atrial function. J Thorac Cardiovasc Surg 2007; 133:174–181.
De Maat GE, Benussi S, Hummel YM, et al. Surgical left atrial appendage exclusion does not impair left atrial contraction function: A Pilot Study. Biomed Res Int 2015; 2015:1–7.
Dar T, Afzal MR, Yarlagadda B, et al. Mechanical function of the left atrium is improved with epicardial ligation of the left atrial appendage: insights from the LAFIT-LARIAT Registry. Heart Rhythm 2018; 15:955–959.
Coisne A, Pilato R, Brigadeau F, et al. Percutaneous left atrial appendage closure improves left atrial mechanical function through Frank-Starling mechanism. Heart Rhythm 2017; 14:710–716.
Phan QT, Shin SY, Cho IS, et al. Impact of left atrial appendage closure on cardiac functional and structural remodeling: a difference-in-difference analysis of propensity score matched samples. Cardiol J 2019; 26:519–528.
Azizy O, Lind A, Janosi RA, et al. Preserved left atrial function following left atrial appendage closure for stroke prevention. J Invasive Cardiol 2021; 33:E40–E44.
Yücel G, Behnes M, Barth C, et al. Percutaneous closure of left atrial appendage significantly affects lipidome metabolism. Sci Rep 2018; 8:5894–5906.
Sattler K, Behnes M, Barth C, et al. Occlusion of left atrial appendage affects metabolomic profile: focus on glycolysis, tricarboxylic acid and urea metabolism. Metabolomics 2017; 13:127–135.
Fastner C, Behnes M, Sartorius B, et al. Interventional left atrial appendage closure affects the metabolism of acylcarnitines. Int J Mol Sci 2018; 19:500–511.
Rusnak J, Behnes M, Saleh A, et al. Interventional left atrial appendage closure may affect metabolism of essential amino acids and bioenergetic efficacy. Int J Cardiol 2018; 268:125–131.
