| BACKGROUND:Left atrial appendage occlusion(LAAO)device has become an anticoagulant replacement therapy for embolic stroke prevention in patients with non-valvular atrial fibrillation(NVAF).The left atrial appendage has the function of secreting cardiac vasoactive neuroendocrine hormones for cardiovascular homeostasis and plays an important buffer role in the mechanical contractile activity of the left atrium.The hemodynamic effect of LAA closure on cardiac function is still inconclusive,and further studies are needed to observe the effect of LAAO on LA function and the combined effect between LAAO + atrial fibrillation CA.Objective:To observe the changes of left ventricular structure and function in patients after left atrial appendage occlusion and the effect of LAAO + CA combination therapy on LA function,and to further explore the interaction between LAAO and CA.METHODS:A retrospective analysis was performed on patients with atrial fibrillation who underwent radiofrequency ablation or left atrial appendage closure in the Second Affiliated Hospital of Nanchang University from 2018 to 2021,including 16 patients with atrial fibrillation who underwent radiofrequency ablation alone,14 patients with atrial fibrillation who underwent left atrial appendage closure + radiofrequency ablation,and 28 patients with atrial fibrillation who underwent LAAO alone.All patients underwent comprehensive 2D transthoracic echocardiography(TTE)+ tissue Doppler before surgery and TTE at 3 and 6 months after surgery.Repeated measures analysis of variance was used to statistically analyze the preoperative/postoperative2 D echocardiographic measurements including left ventricular score,diastolic parameters,and left atrial and left ventricular structural parameters.The changes of NYHA functional classification were also followed up.Results:There were significant differences in E/e ’,and E between the LAAO group and the control group at 6-month follow-up(p < 0.05).The E/e ’of the LAAO group increased from 13.767 ± 4.271 to 16.149 ± 4.434(p< 0.05),and also increased in the LAAO + CA combination group,but the change was not statistically different(p>0.05),and decreased from 14.04 ± 4.873 to 12.02 ± 2.995 in the CA alone group(p = 0.054).The PAD value increased from 22.50 ± 3.097 to 22.89 ± 3.381 in the LAAO group,but did not change significantly in the LAAO + CA group(p> 0.05);CA alone showed a decreasing change,but there was no statistically significant difference(p > 0.05).The E value in the LAAO group increased from 91.57 ±23.996 to 103.21 ± 15.768(p < 0.05).The LVEF value increased in the CA-only group,but there was no statistically significant difference(p = 0.076),while there was no significant change in the LAAO + CA group,with no statistically significant difference(p > 0.05).At 6-month follow-up,we found no significant differences in left ventricular structural parameters among the three groups,including left atrial diameter,end-diastolic diameter,end-systolic diameter,and fractional shortening.There were subtle changes in NYHA functional classification after operation in the three groups,but the difference had no statistical significance(p > 0.05).CONCLUSION:Changes in cardiac hemodynamics after left atrial appendage occlusion for non-valvular atrial fibrillation,mainly increased LV filling pressure(assessed by E/e’),no significant change in left ventricular structure,and no effect on left ventricular systolic function.There was some difference in the effect on left heart function between patients treated with LAAO + CA and those treated with CA alone.After CA,the LAD was reduced,LV filling pressure was reduced,and LVEF was increased.There was no significant effect on left ventricular function(based on postoperative TTE parameters and NYHA functional classification)after combined treatment.This indicate that the combination of LAAO and CA did not produce a synergistic effect on left ventricular function. |
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