title: Electrolyte and hemodynamic changes following percutaneous left atrial appendage ligation with the LARIAT device.
abstract: OBJECTIVE
  The left atrial appendage (LAA) is a well-known source of atrial natriuretic peptide (ANP) and therefore plays an important role in homeostasis. The neurohormonal impact of epicardial exclusion of the LAA with the LARIAT procedure is unknown. In this proof-of-concept study, we postulated that LAA exclusion would impact homeostasis as evidenced by changes in electrolytes and blood pressure (BP).
  
  
  METHODS
  A total of 76 patients who underwent successful LAA exclusion were enrolled in this retrospective observational study utilizing a prospective registry. Electrolytes, BP, and heart rate (HR) were monitored before LARIAT and post-LARIAT (24 and 72 h and 6 months).
  
  
  RESULTS
  There was a significant reduction of systolic BP (mmHg) at 24 h (113.3 ± 16.0; p < 0.0001) and 72 h (119.0 ± 18.4 mmHg; p < 0.0001) post-LARIAT when compared with pre-LARIAT BP (138.2 ± 21.3). The reduction in systolic BP persisted at 6-month follow-up (128.8 ± 17.3; p = 0.0005). There was significant reduction in serum sodium (mmol/L) at 24 h (135.4 ± 3.6; p < 0.0001) and 72 h (136.3 ± 3.7; p < 0.001) post-LARIAT when compared to pre-LARIAT (138.7 ± 3.2). The reduction in sodium was not persistent at 6-month follow-up (138.4 ± 3.3; p = 0.453).
  
  
  CONCLUSIONS
  LAA exclusion results in an early and persistent decrease in systolic BP. Additionally, there is an early decline in serum sodium, which normalizes at long-term follow-up. The underlying mechanism leading to these changes is not entirely clear; however, it is likely related to neurohormonal changes post LAA exclusion.
authors.affiliation: Division of Cardiovascular Diseases, Cardiovascular Research Institute, Mid America Cardiology, University of Kansas Hospital & Medical Center, Kansas City, KS, USA.
authors.forename: Ryan
authors.initials: R
authors.lastname: Maybrook
authors.forename: Jayasree
authors.initials: J
authors.lastname: Pillarisetti
authors.forename: Vivek
authors.initials: V
authors.lastname: Yarlagadda
authors.forename: Sampath
authors.initials: S
authors.lastname: Gunda
authors.forename: Arun Raghav Mahankali
authors.initials: AR
authors.lastname: Sridhar
authors.forename: Brent
authors.initials: B
authors.lastname: Deibert
authors.forename: Muhammad R
authors.initials: MR
authors.lastname: Afzal
authors.forename: Madhu
authors.initials: M
authors.lastname: Reddy
authors.forename: Donita
authors.initials: D
authors.lastname: Atkins
authors.forename: Matthew
authors.initials: M
authors.lastname: Earnest
authors.forename: Ryan
authors.initials: R
authors.lastname: Ferrell
authors.forename: Jayant
authors.initials: J
authors.lastname: Nath
authors.forename: Arun
authors.initials: A
authors.lastname: Kanmanthareddy
authors.forename: Sudharani
authors.initials: S
authors.lastname: Bommana
authors.forename: Rajasingh
authors.initials: R
authors.lastname: Johnson
authors.forename: Sandeep Reddy
authors.initials: SR
authors.lastname: Koripalli
authors.forename: Buddhadeb
authors.initials: B
authors.lastname: Dawn
authors.forename: Dhanunjaya
authors.initials: D
authors.lastname: Lakkireddy
mesh_terms: D020517:Atrial Appendage / Q000503:physiopathology / Q000601:surgery*; D001281:Atrial Fibrillation / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D001794:Blood Pressure; D004867:Equipment Design; D005260:Female; D006801:Humans; D006973:Hypertension / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology*; D008026:Ligation / Q000009:adverse effects / Q000295:instrumentation; D008297:Male; D008875:Middle Aged; D012042:Registries; D012189:Retrospective Studies; D013536:Suture Techniques / Q000009:adverse effects* / Q000295:instrumentation*; D016896:Treatment Outcome; D014882:Water-Electrolyte Balance; D014883:Water-Electrolyte Imbalance / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology*