Left atrial remodeling and brain natriuretic peptide levels variation after left atrial appendage occlusion

Background Few data are available about BNP variation and left atrium remodeling after left appendage occlusion (LAAO) technique. Methods Prospective study, including all consecutive patients successfully implanted with a LAAO device. Contrast-enhanced cardiac computed tomography (CT) performed before and 6 weeks after the procedure with reverse left atrial remodeling define by an increase in LA volume > 10%, together with blood sampling obtained before, 48hr after device implantation and at the first visit after discharge (30–45 days) for BNP measurement. Results Among the 44 patients implanted with a complete dataset, mean End-diastolic LA volume was 139 ± 64 mL and 141 ± 62 mL at baseline and during follow-up (45 ± 15 days), respectively, showing no statistical difference (P = 0.45). No thrombus was seen on the atrial side of the device. Peridevice leaks (defined as presence of dye in LAA beyond the device) were observed in 17 patients (40%) but were trivial or mild. Reverse atrial remodeling (RAR) at 6 weeks was observed in 6 patients (13%). Despite no difference in BNP levels on admission, median BNP levels at 48 Hs was slightly increased in RAR patients when compared with controls. During FU, BNP levels were strictly identical in both groups. These results were not modified even when each RAR case was matched with 2 controls on age, LVEF, creatinine levels and ACE inhibitors treatment to avoid potential confounders. Conclusion Our study showed that despite the fact that LAAO technique can induce left atrial remodeling measured by CT-scan, it does not seems to impact BNP levels on the follow-up. The results need to be transposed to clinical outcomes of this expanding population, in future studies.