Abstract 16367: Does Left Atrial Appendage Exclusion Using an Epicardial System Reduce Systemic Blood Pressures? - The Dawn of a New Frontier
Introduction: Hypertension causes significant systemic and cardiovascular morbidity and mortality. While pharmacologic agents are helpful, renovascular interventions had mixed results. LAA is a unique cardiac vestige and is an integral part of Renin Angiotensin Activation System. We hypothesized that LAA elimination using a clip (AtriClip), suture ligation (Lariat) and or surgical excision in patients with atrial fibrillation could potentially down regulate the RAAS and result in lower BPs.
Methods: In this observational study 186 consecutive patients with AF (71% men; age 73±6; CHAD2 2.8±1.6; HASBLED 3.8±1.6;) who underwent successful epicardial LAA exclusion (Lariat – 135, Atriclip-30, Surgical excision-21) were enrolled. Heart rates and blood pressures were recorded at baseline in the clinic setting, pre surgery, post-surgery @ discharge, @ 3 and 12 months.
Results: There was a significant decrease in mean SBP and DBP in the group from baseline to 24hr,3mon and 12 mon post procedure. Mean AntiHTNsive drugs decreased from 3±1 to 1.6±0.4 (p<0.01) at 56% decrease in the dosing of each. hypotensive response was seen 16-24 hours post procedure in more than 75% of patients undergoing procedure. 6% developed mild renal insufficiency at 24 hours and complete resolution subsequently.
Conclusions: LAA exclusion in patients with AF and known HTN results in significant BP reductions and the need for antihypertensive drugs. We should study this therapy for multi drug resistant HTN pts.
Author Disclosures: D. Lakkireddy: None. J. Rajasingh: None. S. Iskandar: None. R. Afzal: None. M. Earnest: None. D. Atkins: None. S. Bommana: None. L. Di Biase: None. S. Salzberg: None. B. Ramlawi: None. R. Gopinathannair: Speakers Bureau; Modest; Zoll Medical, American Heart Association. Honoraria; Modest; Boston Scientific. Consultant/Advisory Board; Modest; HealthTrust PG. Research Grant; Significant; Boston Scientific. Speakers Bureau; Significant; Pfizer Inc, Bristol Myers Squibb. Consultant/Advisory Board; Significant; St. Jude Medical. A. Natale: None. J.L. Cox: None.
- © 2016 by American Heart Association, Inc.