Left Atrial Appendage Closure and Systemic Homeostasis: The LAA HOMEOSTASIS Study

Dhanunjaya Lakkireddy, Mohit Turagam, Muhammad Rizwan Afzal, Johnson Rajasingh, Donita Atkins, Buddhadeb Dawn, Luigi Di Biase, Krzysztof Bartus, Saibal Kar, Andrea Natale, David J. Holmes

Research output: Contribution to journalArticle

17 Citations (Scopus)

Abstract

Background The impact of left atrial appendage (LAA) exclusion, comparing an epicardial LAA or an endocardial LAA device, on systemic homeostasis remains unknown. Objectives This study compared the effects of epicardial or endocardial LAA devices on the neurohormonal profiles of patients, emphasizing the roles of the renin-angiotensin-aldosterone system and the autonomic nervous system. Methods This is a prospective, single-center, observational study including 77 patients who underwent LAA closure by an epicardial (n = 38) or endocardial (n = 39) device. Key hormones involved in the adrenergic system (adrenaline, noradrenaline), renin-angiotensin-aldosterone system (aldosterone, renin), metabolic system (adiponectin, free fatty acids, insulin, β-hydroxybutyrate, and free glycerols), and natriuresis (atrial and B-type natriuretic peptides) were assessed immediately before the procedure, immediately after device deployment, at 24 h, and at 3 months follow-up. Results In the epicardial LAA device group, when compared with baseline blood adrenaline, noradrenaline and aldosterone were significantly lower at 24 h and 3 months (p < 0.05). There was no significant change in levels post-endocardial LAA device implantation. After epicardial LAA device implantation, there were significant increases in adiponectin and insulin, with decreased free fatty acids at 3 months. There was no significant change in these levels post-endocardial LAA device. N-terminal pro-A-type natriuretic peptide and N-terminal pro-B-type natriuretic peptide were significantly decreased in the acute phase after epicardial LAA device implantation, which subsequently normalized at 3 months. Post endocardial LAA device implantation, the levels increased immediately and normalized after 24 h. Systemic blood pressure was also significantly lower at all time points after epicardial LAA device implantation, which was not seen post-endocardial LAA device implantation. Conclusions There are substantial differences in hemodynamics and neurohormonal effects of LAA exclusion with epicardial and endocardial devices. Further studies are required to elucidate the underlying mechanism of these physiological changes.

Original languageEnglish (US)
Pages (from-to)135-144
Number of pages10
JournalJournal of the American College of Cardiology
Volume71
Issue number2
DOIs
StatePublished - Jan 16 2018

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Atrial Appendage
Homeostasis
Equipment and Supplies
Brain Natriuretic Peptide
Adiponectin
Renin-Angiotensin System
Aldosterone
Nonesterified Fatty Acids
Epinephrine
Norepinephrine
Insulin
Hydroxybutyrates
Natriuretic Peptides
Natriuresis
Autonomic Nervous System
Atrial Natriuretic Factor
Renin
Adrenergic Agents
Glycerol

Keywords

  • atrial fibrillation
  • LAA exclusion
  • neurohormonal regulation

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Lakkireddy, D., Turagam, M., Afzal, M. R., Rajasingh, J., Atkins, D., Dawn, B., ... Holmes, D. J. (2018). Left Atrial Appendage Closure and Systemic Homeostasis: The LAA HOMEOSTASIS Study. Journal of the American College of Cardiology, 71(2), 135-144. https://doi.org/10.1016/j.jacc.2017.10.092

Left Atrial Appendage Closure and Systemic Homeostasis : The LAA HOMEOSTASIS Study. / Lakkireddy, Dhanunjaya; Turagam, Mohit; Afzal, Muhammad Rizwan; Rajasingh, Johnson; Atkins, Donita; Dawn, Buddhadeb; Di Biase, Luigi; Bartus, Krzysztof; Kar, Saibal; Natale, Andrea; Holmes, David J.

In: Journal of the American College of Cardiology, Vol. 71, No. 2, 16.01.2018, p. 135-144.

Research output: Contribution to journalArticle

Lakkireddy, D, Turagam, M, Afzal, MR, Rajasingh, J, Atkins, D, Dawn, B, Di Biase, L, Bartus, K, Kar, S, Natale, A & Holmes, DJ 2018, 'Left Atrial Appendage Closure and Systemic Homeostasis: The LAA HOMEOSTASIS Study', Journal of the American College of Cardiology, vol. 71, no. 2, pp. 135-144. https://doi.org/10.1016/j.jacc.2017.10.092
Lakkireddy, Dhanunjaya ; Turagam, Mohit ; Afzal, Muhammad Rizwan ; Rajasingh, Johnson ; Atkins, Donita ; Dawn, Buddhadeb ; Di Biase, Luigi ; Bartus, Krzysztof ; Kar, Saibal ; Natale, Andrea ; Holmes, David J. / Left Atrial Appendage Closure and Systemic Homeostasis : The LAA HOMEOSTASIS Study. In: Journal of the American College of Cardiology. 2018 ; Vol. 71, No. 2. pp. 135-144.
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abstract = "Background The impact of left atrial appendage (LAA) exclusion, comparing an epicardial LAA or an endocardial LAA device, on systemic homeostasis remains unknown. Objectives This study compared the effects of epicardial or endocardial LAA devices on the neurohormonal profiles of patients, emphasizing the roles of the renin-angiotensin-aldosterone system and the autonomic nervous system. Methods This is a prospective, single-center, observational study including 77 patients who underwent LAA closure by an epicardial (n = 38) or endocardial (n = 39) device. Key hormones involved in the adrenergic system (adrenaline, noradrenaline), renin-angiotensin-aldosterone system (aldosterone, renin), metabolic system (adiponectin, free fatty acids, insulin, β-hydroxybutyrate, and free glycerols), and natriuresis (atrial and B-type natriuretic peptides) were assessed immediately before the procedure, immediately after device deployment, at 24 h, and at 3 months follow-up. Results In the epicardial LAA device group, when compared with baseline blood adrenaline, noradrenaline and aldosterone were significantly lower at 24 h and 3 months (p < 0.05). There was no significant change in levels post-endocardial LAA device implantation. After epicardial LAA device implantation, there were significant increases in adiponectin and insulin, with decreased free fatty acids at 3 months. There was no significant change in these levels post-endocardial LAA device. N-terminal pro-A-type natriuretic peptide and N-terminal pro-B-type natriuretic peptide were significantly decreased in the acute phase after epicardial LAA device implantation, which subsequently normalized at 3 months. Post endocardial LAA device implantation, the levels increased immediately and normalized after 24 h. Systemic blood pressure was also significantly lower at all time points after epicardial LAA device implantation, which was not seen post-endocardial LAA device implantation. Conclusions There are substantial differences in hemodynamics and neurohormonal effects of LAA exclusion with epicardial and endocardial devices. Further studies are required to elucidate the underlying mechanism of these physiological changes.",
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author = "Dhanunjaya Lakkireddy and Mohit Turagam and Afzal, {Muhammad Rizwan} and Johnson Rajasingh and Donita Atkins and Buddhadeb Dawn and {Di Biase}, Luigi and Krzysztof Bartus and Saibal Kar and Andrea Natale and Holmes, {David J.}",
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T2 - The LAA HOMEOSTASIS Study

AU - Lakkireddy, Dhanunjaya

AU - Turagam, Mohit

AU - Afzal, Muhammad Rizwan

AU - Rajasingh, Johnson

AU - Atkins, Donita

AU - Dawn, Buddhadeb

AU - Di Biase, Luigi

AU - Bartus, Krzysztof

AU - Kar, Saibal

AU - Natale, Andrea

AU - Holmes, David J.

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N2 - Background The impact of left atrial appendage (LAA) exclusion, comparing an epicardial LAA or an endocardial LAA device, on systemic homeostasis remains unknown. Objectives This study compared the effects of epicardial or endocardial LAA devices on the neurohormonal profiles of patients, emphasizing the roles of the renin-angiotensin-aldosterone system and the autonomic nervous system. Methods This is a prospective, single-center, observational study including 77 patients who underwent LAA closure by an epicardial (n = 38) or endocardial (n = 39) device. Key hormones involved in the adrenergic system (adrenaline, noradrenaline), renin-angiotensin-aldosterone system (aldosterone, renin), metabolic system (adiponectin, free fatty acids, insulin, β-hydroxybutyrate, and free glycerols), and natriuresis (atrial and B-type natriuretic peptides) were assessed immediately before the procedure, immediately after device deployment, at 24 h, and at 3 months follow-up. Results In the epicardial LAA device group, when compared with baseline blood adrenaline, noradrenaline and aldosterone were significantly lower at 24 h and 3 months (p < 0.05). There was no significant change in levels post-endocardial LAA device implantation. After epicardial LAA device implantation, there were significant increases in adiponectin and insulin, with decreased free fatty acids at 3 months. There was no significant change in these levels post-endocardial LAA device. N-terminal pro-A-type natriuretic peptide and N-terminal pro-B-type natriuretic peptide were significantly decreased in the acute phase after epicardial LAA device implantation, which subsequently normalized at 3 months. Post endocardial LAA device implantation, the levels increased immediately and normalized after 24 h. Systemic blood pressure was also significantly lower at all time points after epicardial LAA device implantation, which was not seen post-endocardial LAA device implantation. Conclusions There are substantial differences in hemodynamics and neurohormonal effects of LAA exclusion with epicardial and endocardial devices. Further studies are required to elucidate the underlying mechanism of these physiological changes.

AB - Background The impact of left atrial appendage (LAA) exclusion, comparing an epicardial LAA or an endocardial LAA device, on systemic homeostasis remains unknown. Objectives This study compared the effects of epicardial or endocardial LAA devices on the neurohormonal profiles of patients, emphasizing the roles of the renin-angiotensin-aldosterone system and the autonomic nervous system. Methods This is a prospective, single-center, observational study including 77 patients who underwent LAA closure by an epicardial (n = 38) or endocardial (n = 39) device. Key hormones involved in the adrenergic system (adrenaline, noradrenaline), renin-angiotensin-aldosterone system (aldosterone, renin), metabolic system (adiponectin, free fatty acids, insulin, β-hydroxybutyrate, and free glycerols), and natriuresis (atrial and B-type natriuretic peptides) were assessed immediately before the procedure, immediately after device deployment, at 24 h, and at 3 months follow-up. Results In the epicardial LAA device group, when compared with baseline blood adrenaline, noradrenaline and aldosterone were significantly lower at 24 h and 3 months (p < 0.05). There was no significant change in levels post-endocardial LAA device implantation. After epicardial LAA device implantation, there were significant increases in adiponectin and insulin, with decreased free fatty acids at 3 months. There was no significant change in these levels post-endocardial LAA device. N-terminal pro-A-type natriuretic peptide and N-terminal pro-B-type natriuretic peptide were significantly decreased in the acute phase after epicardial LAA device implantation, which subsequently normalized at 3 months. Post endocardial LAA device implantation, the levels increased immediately and normalized after 24 h. Systemic blood pressure was also significantly lower at all time points after epicardial LAA device implantation, which was not seen post-endocardial LAA device implantation. Conclusions There are substantial differences in hemodynamics and neurohormonal effects of LAA exclusion with epicardial and endocardial devices. Further studies are required to elucidate the underlying mechanism of these physiological changes.

KW - atrial fibrillation

KW - LAA exclusion

KW - neurohormonal regulation

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