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Posted by on Nov 3, 2018 in Hypertension | 0 comments

In a nutshell

This study investigated if left atrial appendage exclusion (LAAE) reduced blood pressure (BP) in patients with atrial fibrillation (AF). They found that this procedure reduced BP in patients with AF.

Some background

Atrial fibrillation (AF) is a condition where the heart has an abnormal rhythm. In order to pump blood through the body, the heart muscle contracts and relaxes in a specific pattern. In AF this pattern is disrupted and blood can pool in the heart. When blood pools it can become thick and form clots. This can cause blockages in blood vessels and lead to heart attacks or stroke. It can also cause high blood pressure (BP).

Patients with AF usually take medication to prevent blood thickening. These drugs are called anti-coagulants (AGs). Long-term treatment with AGs is not possible for all patients with AF. Left atrial appendage exclusion (LAAE) is an alternative option. LAAE is a surgical procedure. It involves blocking off (excluding) an area in the heart (the left atrial appendage, LAA) where blood can pool. This makes it less likely for blood to pool and clot. There are two methods of LAAE – epicardial (EP) and endocardial (EN). It is unclear if EP- or EN-LAAE has any benefits regarding BP as a long-term treatment for AF.

Methods & findings

This study included 371 patients with AF. Patients underwent either EP-LAAE or EN-LAAE. To exclude the LAA, devices were surgically implanted. Patients in the EP group had either an AtriClip or Lariat device. Patients in the EN group had a Watchman device. Following surgery, BP was measured at 3 and 12 months.

Patients that underwent EP-LAAE had significantly lower systolic BP (SBP; BP when the heart contracts) at 3 months (by 7.4 mmHg) and at 12 months (by 8.9 mmHg). Diastolic BP (DBP; BP when the heart relaxes between beats) was also reduced in EP-LAAE patients compared to EN-LAAE at 3 and 12 months. Patients in the EP group were taking less anti-hypertensive medication after surgery. 

The bottom line

The authors concluded that EP-LAAE reduced BP in patients with AF.

The fine print

Patients were taking medication to reduce blood pressure in this study. This may also have had an effect in addition to LAAE.

What’s next?

If you have any concerns regarding BP management, please consult with your physician.

Published By :

Journal of the American College of Cardiology

Date :

Sep 18, 2018

Original Title :

Epicardial Left Atrial Appendage Exclusion Reduces Blood Pressure in Patients With Atrial Fibrillation and Hypertension.

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