IJCS | Volume 31, Nº6, November / December 2018

DOI: 10.5935/2359-4802.20180075 569 ORIGINAL ARTICLE International Journal of Cardiovascular Sciences. 2018;31(6)569-577 Mailing Address: Marta Madeira Serviço de Cardiologia, Centro Hospitalar e Universitário de Coimbra - Quinta dos Vales, S. Martinho do Bispo. Postal Code: 3045-043, Coimbra - Portugal E-mail: marta.jesus.madeira@gmail.com Does Percutaneous Left Atrial Appendage Closure Affect Left Atrial Performance? Marta Madeira,* 1,2 Rogério Teixeira,* 1,2 Liliana Reis, 1 Paulo Dinis, 1 Luís Paiva, 1,2 Ana Botelho, 1 Marco Costa, 1 Lino Gonçalves 1,2 Serviço de Cardiologia, Centro Hospitalar e Universitário de Coimbra - Hospital Geral, 1 Coimbra - Portugal Faculdade de Medicina da Universidade de Coimbra, 2 Coimbra - Portugal * Both authors contributed equally to the paper Manuscript received September 09, 2017, revised manuscript April 11, 2018, accepted July 02, 2018. Abstract Background: Percutaneous left atrial appendage (LAA) occlusionmay be an alternative therapy for atrial fibrillation (AF) patients with contraindication for anti-coagulation therapy. However, the influence of LAA occlusion on left atrial (LA) performance has not been studied. Objective: Our aim was to evaluate the influence of percutaneous LAA occlusion device on LA function by transthoracic echocardiography plus speckle-tracking echocardiography (STE). Methods: We included 16 patients undergoing percutaneous LAA closure with adequate echocardiographic window for the study of LA mechanics. Transthoracic echocardiography was performed before and after the procedure. LA volumes were calculated using the biplane method, and LA mechanics were assessed using STE. The analysis focused on the LA reservoir phase strain and strain rate. Results: Seventy-five percent of patients had permanent atrial fibrillation. Embolic and bleeding risk scores used were CHA 2 DS 2 -VASc [median of 4-5] and HAS-BLED [median of 2-3]. Major bleeding (62%) was the most common indication for the procedure. Percutaneous LAA closure was performed successfully in all patients, without major complications. No differences were found in maximum LA volume (44 ± 11 vs. 46 ± 13 mL/m 2 ; p = 0.54), minimum LA volume (32 ± 8 vs. 37 ± 14 mL/m 2 ; p = 0.09) or LA emptying fraction (26 ± 17 vs. 21 ± 14%; p = 0.33) before and after the procedure. Similarly, no differences were noted in left atrial strain (13.7 ± 11.1 vs. 13.0 ± 8.8%; p = 0.63) or strain rate (1.06 ± 0.26 vs. 1.13 ± 0.34 s -1 ; p = 0.38) in the reservoir phase. Conclusions: Our data suggest that percutaneous LAA closure does not affect LA reservoir function. (Int J Cardiovasc Sci. 2018;31(6)569-577) Keywords: Atrial Fibrillation; Atrial Appendage; Heart Atria; Echocardiography, Transthoracic. Introduction Atrial fibrillation is themost common sustained cardiac arrhythmia, 1 with a current estimated prevalence of 1.5% to 2%. 2 It is considered amajor cause of systemic embolism, increasing the risk for ischemic stroke by 5 times. 2,3 Oral anticoagulation has been shown to effectively reduce the risk for stroke in patients with atrial fibrillation and is one of the cornerstones of management. 2 However, a significant proportion (30% - 50%) of eligible patients do not receive oral anticoagulation due to the presence of absolute contraindications or a perceived high risk of bleeding. 3 Several studies have shown that, in patients with nonvalvular atrial fibrillation, 90% of thrombus formation occurs in the left atrial appendage (LAA). 4,5 Therefore, devices for LAA closure have been developed as an alternative to oral anticoagulation in patients at high risk for stroke with contraindications to anticoagulation therapy. 6 Recently, the non-inferiority of LAA exclusion over warfarin for stroke prevention was demonstrated in patients with nonvalvular atrial fibrillation. 7 It was previously believed that the LAAwas a vestigial structure with no meaningful function. LAA is now thought to play an important role in normal cardiac