CLINICAL RESEARCH: ATRIAL FIBRILLATION AN THROMBI
Left atrial structure and function after percutaneous left atrial appendage transcatheter occlusion (PLAATO)
Six-month echocardiographic follow-up
Ibrahim R. Hanna, MD*,
Paul Kolm, PhD*,
Randolph Martin, MD, FACC*,
Mark Reisman, MD, FACC ,
William Gray, MD, FACC and
Peter C. Block, MD, FACC*,*
* Division of Cardiology, Department of Medicine, Emory University, Atlanta, Georgia, USA
Swedish Cardiovascular Research, Seattle, Washington, USA
Manuscript received November 25, 2003;
revised manuscript received December 17, 2003,
accepted December 23, 2003.
* Reprint requests and correspondence: Dr. Peter C. Block, Division of Cardiology, Emory University Hospital, 1634 Clifton Road, Suite F606, Atlanta, Georgia 30322, USA.
peter_block{at}emoryhealthcare.org
OBJECTIVES: This study was designed to evaluate the effects of percutaneous left atrial appendage transcatheter occlusion (PLAATO) on the anatomic and hemodynamic properties of the mitral valve (MV) and left upper pulmonary vein (LUPV).
BACKGROUND: PLAATO is a device designed to seal the neck of the left atrial (LA) appendage and reduce embolization in patients with atrial fibrillation intolerant of warfarin. The impact of deployment of this device on adjacent structures has not been reported.
METHODS: Patients with atrial fibrillation participating in the ongoing study for evaluation of PLAATO were enrolled. Transesophageal echocardiographies at baseline, one, and six months were reviewed to measure LA and LUPV dimensions, degree of mitral regurgitation, stability of the device, peak MV E-wave velocity, and peak systolic and diastolic flow velocities in the LUPV. Data were analyzed by a linear mixed model for repeated measures.
RESULTS: Eleven patients (mean age of 72 ± 7 years) completed six months of follow-up. Left upper pulmonary vein diameter (mean: 1.55, 1.61, 1.54 cm, p = 0.13) and peak systolic (mean: 0.38, 0.34, 0.31 m/s, p = 0.72) and diastolic flow velocities (mean: 0.39, 0.40, 0.42 m/s, p = 0.46) did not differ over the follow-up period. Left atrial size, mitral regurgitation severity, and MV peak E-wave velocities (mean: 0.94, 0.94, 0.82 m/s, p = 0.58) showed no significant change from baseline. The devices remained stable at their sites of deployment with minimal residual flow around them.
CONCLUSIONS: PLAATO achieved an adequate seal of the neck of the left atrial appendage without significant effect on the structure or function of the LA and LUPV.
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Abbreviations and Acronyms
| | AF | = atrial fibrillation | | INR | = international normalized ratio | | LA | = left atrium | | LAA | = left atrial appendage | | LUPV | = left upper pulmonary vein | | MR | = mitral regurgitation | | MV | = mitral valve | | PLAATO | = percutaneous left atrial appendage transcatheter occlusion | | TEE | = transesophageal echocardiography |
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