cad a22 4500 555301583 20200417040255.0 cr unu---uuuuu 190206e20180918xx s 000 0 eng 10.1016/j.jacc.2018.06.066 doi (ZORA)oai:www.zora.uzh.ch:165378 610 ddc 30213326 pmid Epicardial Left Atrial Appendage Exclusion Reduces Blood Pressure inPatients With Atrial Fibrillation andHypertension [Elektronische Daten] [Mohit K Turagam, Venkat Vuddanda, Niels Verberkmoes, Toshiya Ohtsuka, Ferdi Akca, Donita Atkins, Sudharani Bommana, Maximilian Y Emmert, Rakesh Gopinathannair, Gansevoort Dunnington, Abdi Rasekh, Jie Cheng, Sacha Salzberg, Andrea Natale, James Cox, Dhanunjaya R Lakkireddy] closedAccess eu-repo BACKGROUND Percutaneous left atrial appendage exclusion (LAAE) has evolved as an alternative strategy for stroke prevention in atrial fibrillation (AF). Recent observational data have suggested that epicardial LAAE can have substantial impact on arrhythmia burden and hemodynamic profile. OBJECTIVES The authors aimed to study the impact of epicardial versus endocardial LAAE on systemic blood pressure in hypertensive AF patients. METHODS This was a prospective, nonrandomized study comparing 247 patients who underwent epicardial LAAE with 124 patients with endocardial exclusion. Clinical outcomes were measured at 3months and 1 year. Primary outcome was improvement in systolic blood pressure (SBP) between both groups compared with baseline. Secondary outcome included changes in diastolic pressures (DBP), serum electrolytes, and creatinine. RESULTS There was no significant difference in baseline SBP between epicardial and endocardial groups. SBP was significantly lower in the epicardial group both at 3months (122 ± 11.8mmHg vs. 129.7 ± 8.2mmHg; p< 0.001) and 1year (123 ± 11.6mmHg vs. 132.2 ± 8.8mmHg; p< 0.001) compared with the endocardial group. An adjusted multivariate linear mixed effects model demonstrated that epicardial LAAE significantly decreased SBP by 7.4mmHg at 3months and by 8.9mmHg at 1 year (p< 0.0001). There was a trend toward lower DBP with epicardial LAAE at 3months by 1.3mmHg (p=0.2) and at 1 year by 1.8mmHg (p=0.09). There was no significant difference in serum electrolytes and creatinine between both groups. CONCLUSIONS In hypertensive AF patients, epicardial LAAE significantly decreases SBP both at 3 and 12months compared with endocardial exclusion. Clinic for Vascular Surgery zora Institute for Regenerative Medicine (IREM) zora atrial fibrillation Hypertension left atrial appendage renin-angiotensin-aldosterone system zora Turagam Mohit K. joint author Vuddanda Venkat joint author Verberkmoes Niels joint author Ohtsuka Toshiya joint author Akca Ferdi joint author Atkins Donita joint author Bommana Sudharani joint author Emmert Maximilian Y. joint author Gopinathannair Rakesh joint author Dunnington Gansevoort joint author Rasekh Abdi joint author Cheng Jie joint author Salzberg Sacha joint author Natale Andrea joint author Cox James joint author Lakkireddy Dhanunjaya R. joint author Journal of the American College of Cardiology 72(12):1346-1353 https://www.zora.uzh.ch/165378 text/html WWW-Backlink auf das Repository 1 Journal Article PeerReviewed zora ZORA 856 40 https://www.zora.uzh.ch/165378 text/html WWW-Backlink auf das Repository ZORA 700 1- Turagam Mohit K. joint author ZORA 700 1- Vuddanda Venkat joint author ZORA 700 1- Verberkmoes Niels joint author ZORA 700 1- Ohtsuka Toshiya joint author ZORA 700 1- Akca Ferdi joint author ZORA 700 1- Atkins Donita joint author ZORA 700 1- Bommana Sudharani joint author ZORA 700 1- Emmert Maximilian Y. joint author ZORA 700 1- Gopinathannair Rakesh joint author ZORA 700 1- Dunnington Gansevoort joint author ZORA 700 1- Rasekh Abdi joint author ZORA 700 1- Cheng Jie joint author ZORA 700 1- Salzberg Sacha joint author ZORA 700 1- Natale Andrea joint author ZORA 700 1- Cox James joint author ZORA 700 1- Lakkireddy Dhanunjaya R. joint author ZORA 773 0- Journal of the American College of Cardiology 72(12):1346-1353 BK010053 XK010053 XK010000 ZORA ZORA ZORA Journal Article closedAccess