Comparison of cardiac function and structure after left atrial appendage occlusion without versus with ablation in patients with non-valvular atrial fibrillation: a retrospective study

Comparison of cardiac function and structure after left atrial appendage occlusion without versus with ablation in patients with non-valvular atrial fibrillation: a retrospective study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Article Comparison of cardiac function and structure after left atrial appendage occlusion without versus with ablation in patients with non-valvular atrial fibrillation: a retrospective study Zhong-bao Ruan, Fei Wang, Ge-cai Chen, Jun-guo Zhu, Yin Ren, Li Zhu This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-3826129/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background Regarding the physiology role of left atrial appendage (LAA), whether occlusion of LAA or combined with ablation has any influence on cardiac function and structure in patients with non-valvular atrial fibrillation (NVAF) is still unclear. Aims To compare the influence on cardiac function and structure after left atrial appendage occlusion (LAAO) without versus with ablation in patients with NVAF. Methods 157 patients with NVAF who underwent LAAO or combined with ablation were included and divided into Simple LAAO group or Combined group. Long term impact on cardiac function and structure between the two groups were compared. Results There was a significant decrease of left atrial anteroposterior diameter (LAAD) at 6 months and a significant increase of left ventricular end-diastolic dimension (LVEDD) at 12 months after LAAO. A significant decrease in plasma N-terminal pro-brain natriuretic peptide (NT-proBNP) was noted at 3 months, 6 months and 12 months after LAAO. Subgroup analysis indicated that there was a significant decrease of LAAD, LVEDD, LVESD and NT-proBNP levels in Combined group at 3 months, 6 months and 12 months post-procedure, while an increase of LVEF. However, no significant change of LAAD, LVEDD, LVESD, NT-proBNP and LVEF was seen in Simple LAAO group at 3 months follow-up, but a decrease of NT-proBNP during 6 months and 12 months follow-up. Compared with Simple LAAO group, Combined group was associated with a significant increase of residual flow. Conclusions LAAO has no significant effect on cardiac structure and function but can significantly reduce NT-proBNP. The improvement of cardiac structure and function in combined therapy comes from the influence of ablation, not LAAO. Health sciences/Cardiology Health sciences/Diseases Health sciences/Medical research left atrial appendage occlusion ablation atrial fibrillation cardiac structure cardiac function Figures Figure 1 Introduction Atrial fibrillation (AF) is one of the most common arrhythmias and the incidence increases with age [ 1 ]. Thromboembolic complication is the leading cause of death and disability in patients with AF [ 2 ]. Studies have shown that left atrial appendage (LAA) is the main cardioembolic site in non-valvular atrial fibrillation (NVAF) [ 3 ]. Left atrial appendage occlusion (LAAO) has now been shown to be a safety and effective alternative therapy to oral anticoagulation (OAC) for preventing stroke in NVAF patients with high-risk [ 4 ]. Emerging evidence indicates that LAA is a contractile and compliant organ that involves in the regulation of pressures in the left atrium and plays an important role in the preservation of left ventricular filling. Meanwhile, it is one of the major hormone-producing sites, involves in neurohormonal secretion such as brain natriuretic peptide (BNP) and atrial natriuretic peptide (ANP) [ 5 , 6 ], which can affect cardiac function and structure and prevent the development and progression of heart failure (HF) [ 7 ]. Regarding the physiology role of the LAA, whether occlusion of the LAA may have any deleterious effects on the human body are still unclear to medical science so far. There are several reports provided inconsistent results about the impact of LAAO on cardiac function and structure in NVAF patients [ 8 – 11 ]. Therefore, in this study, we aimed to investigate the effect of LAAO on cardiac structure and function in patients with NVAF through long term follow-up after LAAO. Moreover, the combination strategy of LAAO for stroke prevention and catheter ablation for AF symptoms controlling was proposed and the feasibility and safety were proven [ 12 , 13 ]. However, the effect of combination therapy on cardiac function and structure has not been investigated. Therefore, the impact of combination therapy on cardiac function and structure were investigated at the same time. Meanwhile, comparison of cardiac function and structure after LAAO without versus with ablation in patients with NVAF was perfprmed. Methods Study population This study included 157 patients with NVAF who underwent Watchman LAAO or combined with radiofrequency catheter ablation (RFCA) / cryoballoon ablation (Cryo) at Jiangsu Taizhou People's Hospital from March 2018 to November 2020, and the diagnosis of NVAF was mainly based on the criteria listed in the 2020 ESC Guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS) [ 14 ]. All patients met the inclusion criteria: ① definite diagnosis of NVAF refractory to antiarrhythmic drugs; ② Age ≥ 18 years; ③ CHA2DS2-VASc score ≥ 2 (male) or ≥ 3 (female); ④ Intolerant or unwilling to long-term anticoagulant therapy or contraindicated with anticoagulant drugs; The exclusion criteria were as follows: ① Transesophageal echocardiography (TEE) or CT angiography (CTA) showed thrombus in left atrium or LAA before operation; ② left atrial anteroposterior diameter (LAAD) > 65 mm for LAAO or > 55 mm for radiofrequency ablation/cryoablation; ③ LAA ostium 31 mm; ④ patients with rheumatic or valvular heart disease; ⑤ history of stroke within 1 month; ⑥cardiac function class IV (NYHA class New York); ⑦ inadequate control of hypertension; ⑧ coagulopathy. A total of 157 subjects were included in the study after screening. The study was approved by the hospital ethics committee and all patients signed the informed consent form. Data Collection The relevant laboratory tests (including routine blood tests, coagulation, biochemistry index, thyroid function and plasma N-terminal pro-brain natriuretic peptide (NT-proBNP) and routine electrocardiogram were performed preoperatively. Clinical data were collected including age, gender, body mass index (BMI) (Kg/m 2 ), type of NVAF, New York Heart Association (NYHA) functional classification, medical history (including hypertension, diabetes mellitus, coronary artery disease, congestive heart failure/cardiac insufficiency, peripheral vascular disease, hepatic insufficiency, renal insufficiency), history of thromboembolism (including stroke/transient ischemic attack), history of hemorrhage, CHA2DS2-VASc score, HAS-BLED score, perioperative adverse events. TEE and CTA protocol TEE (Philips EPIQ 7C ) and CTA(Siemens 128-row SOMATOM Force, Germany) were underwent to eliminate LA A thrombus and to calculate the orifice diameter and depth of LAA before the procedure. Meanwhile, the following parameters were collected by TEE including left atrial anteroposterior diameter (LAAD), left ventricular end-diastolic dimension (LVEDD), left ventricular end-systolic dimension (LVESD) and left ventricular ejection fraction (LVEF). The TEE operator was the same at baseline and follow up. LAAO procedure using the Watchman2.5 device LAAO procedure was performed under deep intravenous anesthesia or general anesthesia and TEE monitoring. Following successful transseptal puncture, angiography of LAA was performed to measure the orifice diameter and depth of LAA. Based on the measured parameters on diameter and depth of LAA by TEE, CTA and digital subtraction angiography (DSA), oversizing by 4 mm–6 mm of the diameter of the LAA was selected as a suitable device size. The Watchman2.5 device was released when the conditions of a proper position with no or minimal (< 5 mm) residual flow and a safety tug test were met by DSA and TEE. RFCA and Cryo procedure In combined group, RFCA or Cryo was performed before LAAO. RFCA was used in 65 patients with persistent or paroxysmal atrial fibrillation. The left atrium and pulmonary vein models were constructed with CARTO three-dimensional mapping system (CARTO R 3; Biosense Webster, Irvine, CA, USA), pulmonary vein isolation (PVI) was performed in all patients with Coolflex catheters. For persistent atrial fibrillation, left atrial substrate mapping and homogenous ablation of low voltage areas were performed. Cryo was used in 21 patients with paroxysmal atrial fibrillation. A 28mm diameter of second generation cryoballoon (Arctie Front @ Cryoablation Catheter, Medtronic Inc., USA) was used for the purpose of PVI. Post-procedural anticoagulation The therapy of anticoagulation combiner with antiplatelet was recommended for 3 months following the procedure. Antiarrhythmic drugs were also used for 3 months in patients with combined procedure. Dual antiplatelet therapy with aspirin and clopidogrel was recommended for another 3 months if there were neither thromboembolism nor persistent peri-device leaks more than 5 mm detected by TEE follow-up. Then aspirin or clopidogrel was recommended indefinitely. Follow-up Patients were followed up at 3 months, 6 months and 12 months post- procedure. During the follow-up, adverse events including thromboembolic events, bleeding events and mortality etc were recorded. TEE was performed and the plasma NT-proBNP was measured to evaluate the changes of cardiac function and structure. Residual leak and device-related thrombus (DRT) formation were also assessed by TEE. Statistical analysis Statistical software SPSS 26.0 was used for analysis, Kolmogorov-Smirnov test was used to test whether the data were normal distribution. The normal distribution in the measurement data was presented as mean ± standard deviation, and paired sample t-test is used for comparison. Categorical data were presented as counts and percent and chi-square test were applied. A p value < 0.05 was considered statistically significant. Results Clinical baseline characteristics Patient disposition was summarized in Fig. 1 . In this study, of the 157 patients, 76 underwent LAAO only (Simple LAAO group) and 81 underwent LAAO alongside ablation (Combined group). The mean age was 67.4 ± 8.9 years, the mean CHA 2 DS 2 -VASc score was 3.06 ± 1.06 and HAS-BLED score 2.78 ± 0.81. There were 109 (69.4%), 73 (46.5%), 38 (24.2%), 46 (29.3%), 35 (22.3%) and 5 (3.2%) of the patients suffering from hypertension, congestive heart failure, diabetes mellitus, prior stroke, coronary heart disease and bleeding history, respectively. The detailed clinical baseline characteristics were shown in Table 1 . Table 1 Baseline characteristics of the population Baseline characteristics n = 157 Male, n(%) 91(58.0) Age(years) 67.4 ± 8.9 BMI(Kg/m²) 25.0 ± 3.4 Paroxysmal AF, n(%) 43(27.4) Persistent AF, n(%) 114(72.6) CHA2DS2-VASc score 3.06 ± 1.06 HAS-BLED score 2.78 ± 0.81 Medical history Hypertension, n (%) 109(69.4) Heart failure, n (%) 73(46.5) Diabetes mellitus, n (%) 38(24.2) Stroke history, n (%) 46(29.3) Coronary heart disease, n (%) 35(22.3) Abnormal liver function, n (%) Abnormal rennal function, n (%) Hemorrhage history, n (%) 31(19.7) 4(2.5) 5(3.2) Medications Antiplatelet agents, n (%) 35 (22.3) Oral anticoagulants, n (%) 96 (61.1) Warfarin, n (%) 27 (17.2) New oral anticoagulants, n (%) 69 (43.9) BMI: body mass index; AF: atrial fibrillation. Assessment of the periprocedural parameters The LAAO procedure with Watchman2.5 occluders or combined procedure was performed successfully in included patients. The LAA ostial diameter and depth measured by preoperative CTA (diameter: 23.6 ± 3.7 mm, depth: 25.1 ± 3.9 mm) was greater than those by TEE (diameter: 22.4 ± 3.6 mm, depth: 23.8 ± 3.6 mm) and DSA (diameter: 22.9 ± 3.7 mm, depth: 24.6 ± 3.7 mm). There were 11 (7.0%), 28 (17.8%), 49(31.2%), 30 (19.1%) and 39(24.8%) of all Watchman2.5 devices for 21 mm, 24 mm, 27 mm, 30 mm and 33 mm, respectively. There were 129 (82.2%) patients without no residual leak, 24 (15.3%) patients with residual leak less than 3 mm, 4 (2.5%) patients with residual leak between 3 mm and 5 mm. After LAAO, shoulder exposure was happened in 31 cases (19.7%) and the mean compression ratio was (21.6 ± 4.6) %. There were 10 (6.4%) cases with complications, in which, cardiac tamponade was found in 2 (1.3%)cases during and after the operation, micropericardial effusion was occurred in 5 (3.2%) cases. Detailed data were present in Table 2 . Table 2 The periprocedural parameters Periprocedural parameters n = 157 Procedure method Cryo + LAAO 51(32.5) RFCA + LAAO 30(19.1) LAAC 76(48.4) Device size 21mm, n(%) 11(7.0) 24mm, n(%) 28(17.8) 27mm, n(%) 49(31.2) 30mm, n(%) 30(19.1) 33mm, n(%) 39(24.8) LAA orifice diameter (mm) CTA 23.6 ± 3.7** TEE 22.4 ± 3.6 DSA 22.9 ± 3.7 LAA length (mm) CTA 25.1 ± 3.9** TEE 23.8 ± 3.6 DSA 24.6 ± 3.7 Residual flow 0mm, n(%) 129(82.2) <3mm, n(%) 24(15.3) 3-5mm, n(%) 4(2.5) ≥ 5mm, n(%) 0 Exposure shoulder of occluders Yes, n(%) 31(19.7) No, n(%) 126(80.3) Compression ratio of occluder(%, ‾x ± s) 21.6 ± 4.6 Complications 10((6.4) Pericardial effusion, n (%) 5(3.2) Cardiac tamponade, n (%) 2(1.3) Vagal reflex, n (%) 2(1.3) Phrenic nerve palsy, n (%) 1(0.65) Cryo: Cryoballoon ablation; LAAC: Left atrial appendage occlusion; RFCA: Radiofrequency catheter ablation; LAA: Left atrial appendage; CTA: CT angiography ; TEE: transesophageal echocardiography;DSA: Digital subtraction angiograph.** Compared with TEE, p < 0.01. Impact of LAAO or combined with ablation on cardiac function and structure As shown in Table 3 , there were 157 patients, 122 patients and 81 patients completed the follow-up at 3 months, 6 months and 12 months, respectively. There was a significant decrease of LAAD at 6 months. Meanwhile, a significant increase of LVEDD was seen at 12 months after LAAO. No significant impact was indicated in LVESD and LVEF. However, the LAAO therapy was associated with a significant decrease in plasma NT-proBNP level at 3 months, 6 months and 12 months after operation. Table 3 Evolution of cardiac function after procedure LAAD (mm) LVEDD (mm) LVESD (mm) LVEF (%) NT-proBNP (pg/ml) 3 months (n = 157) Baseline 48.22 ± 6.74 50.46 ± 5.84 33.59 ± 6.31 61.75 ± 9.41 1154.30 ± 678.90 Post-procedure 47.82 ± 6.55 50.51 ± 5.17 33.48 ± 5.64 62.16 ± 9.22 987.30 ± 514.10 t value 0.533 0.081 0.163 0.391 2.456 p value 0.125 0.994 0.991 0.338 0.019 6 months (n = 122) Baseline 48.34 ± 6.71 50.63 ± 5.63 33.56 ± 6.32 62.24 ± 9.63 1314.36 ± 698.95 Post-procedure 46.48 ± 7.07 50.75 ± 5.38 33.16 ± 5.80 61.75 ± 9.06 1127.50 ± 651.90 t value 2.113 0.171 0.515 0.409 2.159 p value 0.041 0.533 0.230 0.489 0.036 12 months (n = 81) Baseline 47.75 ± 6.56 50.16 ± 4.82 32.83 ± 5.67 62.96 ± 8.79 1255.00 ± 791.31 Post-procedure 47.25 ± 6.79 51.30 ± 4.52 33.49 ± 4.83 62.23 ± 9.20 987.00 ± 572.40 t value 0.476 1.553 0.797 0.516 2.471 p value 0.107 0.013 0.121 0.444 0.023 LAAD: left atrial anteroposterior diameter; LVEDD: left ventricular end-diastolic dimension; LVESD: left ventricular end-systolic dimension; LVEF: left ventricular ejection fraction; NT-proBNP: N-terminal pro-brain natriuretic peptide. Comparison of the influence on cardiac function and structure between Simple LAAO group and Combined group Patients were divided into Simple LAAO group and Combined group according to the procedural approach. Instant PVI with complete LAAO was achieved in combined group. There were 76 patients, 62 patients and 39 patients in simple LAAO group at 3 months, 6 months and 12 months after procedure, while 81 patients, 60 patients and 42 patients in combined group, respectively. Results showed that there was a significant decrease of NT-proBNP levels at 6 months and 12 months after operation in the Simple LAAO group, but not show at 3 months. Meanwhile, no significant change of LAAD, LVEDD, LVESD and LVEF was noted in Simple LAAO group during the 3months, 6 months and 12 months follow-up. However, compared with the baseline, there was significant improvement of LAAD, LVEDD, LVESD, LVEF, NT-proBNP in Combined group at the follow-up periods of 3 months, 6 months, and 12 months. The detailed results were listed in Table 4 , Table 5 and Table 6 . Table 4 Evolution of cardiac function of Simple LAAO group and Combined group at 3 months post- procedure LAAD (mm) LVEDD (mm) LVESD (mm) LVEF (%) NT-proBNP (pg/ml) Simple LAAO group(n = 76) Baseline 51.37 ± 6.40 51.58 ± 6.40 34.66 ± 7.07 61.00 ± 10.78 1315.40 ± 919.18 Post-procedure 50.91 ± 6.56 51.33 ± 5.58 34.46 ± 6.33 61.29 ± 10.17 1160.60 ± 777.75 t value 0.438 0.257 0.184 0.172 1.122 p value 0.214 0.393 0.748 0.923 0.119 Combined group(n = 81) Baseline 45.26 ± 4.59 50.34 ± 4.48 34.42 ± 3.87 60.58 ± 7.89 1003.00 ± 499.00 Post-procedure 42.98 ± 4.56 47.86 ± 4.74 32.09 ± 3.65 64.52 ± 6.59 689.30 ± 378.65 t value 7.111 5.297 6.974 -6.506 4.507 p value 0.000 0.000 0.000 0.000 0.000 LAAO:left artial appendage occlusion; LAAD: left atrial anteroposterior diameter; LVEDD: left ventricular end-diastolic dimension; LVESD: left ventricular end-systolic dimension; LVEF: left ventricular ejection fraction ; NT-proBNP: N-terminal pro-brain natriuretic peptide. Table 5 Evolution of cardiac function of Simple LAAO group and Combined group at 6 months post- procedure LAAD (mm) LVEDD (mm) LVESD (mm) LVEF (%) NT-proBNP (pg/ml) Simple LAAO group(n = 62) Baseline 51.06 ± 6.29 51.21 ± 6.16 34.27 ± 7.06 61.47 ± 11.04 1438.50 ± 939.33 Post-procedure 50.21 ± 7.37 50.18 ± 5.71 34.48 ± 6.27 60.06 ± 10.19 949.84 ± 796.50 t value 0.691 0.965 0.158 0.742 3.124 p value 0.646 0.193 0.888 0.672 0.016 Combined group(n = 60) Baseline 45.06 ± 4.23 50.25 ± 4.41 33.93 ± 3.82 60.22 ± 7.52 1177.26 ± 657.23 Post-procedure 42.55 ± 4.28 47.73 ± 5.74 31.95 ± 3.65 63.41 ± 8.91 877.15 ± 510.53 t value 5.145 3.972 5.102 -3.241 2.793 p value .000 .000 .000 0.002 0.032 LAAO:left artial appendage occlusion; LAAD: left atrial anteroposterior diameter; LVEDD: left ventricular end-diastolic dimension; LVESD: left ventricular end-systolic dimension; LVEF: left ventricular ejection fraction ; NT-proBNP: N-terminal pro-brain natriuretic peptide. Table 6 Evolution of cardiac function of Simple LAAO group and Combined group at 12 months post- procedure LAAD (mm) LVEDD (mm) LVESD (mm) LVEF (%) NT-proBNP (pg/ml) Simple LAAO group(n = 39) Baseline 50.62 ± 5.95 51.59 ± 5.07 34.33 ± 6.38 61.33 ± 9.92 1379.00 ± 884.65 Post-procedure 50.59 ± 6.05 52.51 ± 4.58 34.51 ± 4.99 60.21 ± 8.90 989.40 ± 693.58 t value 0.221 0.840 0.139 0.525 2.164 p value 0.955 0.120 0.812 0.208 0.042 Combined group(n = 42) Baseline 45.14 ± 4.31 50.54 ± 4.51 34.29 ± 3.63 60.19 ± 7.68 1110.50 ± 695.48 Post-procedure 42.69 ± 4.63 48.33 ± 5.71 32.33 ± 4.00 64.14 ± 10.06 739.50 ± 425.68 t value 3.884 2.943 3.845 -3.23 2.949 p value .000 0.005 .000 0.002 0.005 LAAO:left artial appendage occlusion; LAAD: left atrial anteroposterior diameter; LVEDD: left ventricular end-diastolic dimension; LVESD: left ventricular end-systolic dimension; LVEF: left ventricular ejection fraction ; NT-proBNP: N-terminal pro-brain natriuretic peptide. Procedure-related complications in follow-up The Watchman devices of all patients were in place. There were 129 (82.2%) patients, 97 (79.5%) patients and 65 (80.2%) patients wtithout residual flow at 3 momths, 6 months and 12 months, while residual flow less than 3 mm were 24 (15.3%) patients, 21(17.2%) patients and 13 (16.1%) patients, respectively. Compared with simple LAAO group, combined group was associated with a significant decrease of no residual flow and increase of residual flow less than 3 mm (p < 0.05) at the follow-up of 3 momths, 6 months and 12 months. Device-related thrombus was happened in 7 (4.9%) patients, 2 (1.6%) patients and 3 (3.7%) patients at 3 momths, 6 months and 12 months after procedure. Correspondingly, 2 (1.3%) cases, 1 (0.8%) case and 2 (2.5%) cases of stroke were noted, respectively. Bleeding complication was observed in 5 cases at 3 months after operation, including 1 case of gastrointestinal hemorrhage, 1 case of hemoptysis, 1 case of urinary system hemorrhage and 2 cases of skin ecchymosis. At 6 months after operation, hemorrhagic complication was occurred in 3 cases, 1 with gastrointestinal hemorrhage and 2 with ecchymosis. At 12 months, gastrointestinal bleeding occurred in 2 cases. 1 case of death occurred at 8 months post- procedure due to sudden cardiac death. Except the Incidence rate of residual flow, there was no significant diference of the procedure-related complications between simple LAAO group and combined group. The results were displayed in Table 7 . Table 7 Follow-up outcomes 3 months(n = 157) 6 months(n = 122) 12 months(n = 81) Occluder displace, n (%) 0(0.0) 0(0.0) 0(0.0) Residual flow, n (%) 0mm 129(82.2) 97(79.5) 65(80.2) Simple LAAO group 68(89.4) 54(87.1) 35(89.7) Combined group 61(75.3) * 43(71.7) * 30(71.4) * <3mm 24(15.3) 21(17.2) 13(16.1) Simple LAAO group 6(7.9) 6(9.7) 3(7.7) Combined group 18(22.2)* 15(25.0)* 10(23.8)* 3-5mm 4(2.5) 4(3.3) 3(3.7) Simple LAAO group 2(2.6) 2(3.2) 1(2.6) Combined group 2(2.5) 2(3.3) 2(4.8) ≥ 5mm 0(0.0) 0(0.0) 0(0.0) Simple LAAO group 0(0.0) 0(0.0) 0(0.0) Combined group 0(0.0) 0(0.0) 0(0.0) Device-related thrombus 7(4.9) 2(1.6) 3(3.7) Simple LAAO group 3(3.9) 1(1.6) 2(5.1) Combined group 4(4.9) 1(1.7) 1(2.4) Stroke 2(1.3) 1(0.8) 2(2.5) Simple LAAO group 1(1.3) 1(1.6) 1(2.6) Combined group 1(1.2) 0(0.0) 1(2.4) Bleeding 5(3.2) 3(2.6) 2(2.5) Simple LAAO group 3(3.9) 1(1.6) 1(2.6) Combined group 2(2.5) 2(3.3) 1(2.4) Death 0(0.0) 0(0.0) 1(1.2) Simple LAAO group 0(0.0) 0(0.0) 1(2.6) Combined group 0(0.0) 0(0.0) 0(0.0) Post procedure medications Warfarin 24(15.3) 0(0.0) 1(1.2) Dabigatran 106(67.5) 1(0.8) 0(0.0) Rivaroxaban 27(17.2) 1(0.8) 2(2.4) Aspirin 126(80.2) 109(89.3) 69(85.2) Clopidogrel 31(19.8) 122(100) 12(14.8) LAAO:left artial appendage occlusion. *Compared with Simple LAAO group, p < 0.05. Discussion At present, the complication of thromboembolism is the leading cause of death and disability in AF, ischemic stroke due to AF accounts for 20% of all strokes [ 15 ]. It was proven that NVAF-related thrombus was 100% from LAA [ 16 ]. As a safe and effective therapy of stroke prevention, LAAO provides a viable alternative for oral anticoagulants and has been recommended for the prevention of AF stroke by the guidelines [ 17 ]. However, the impact of LAAO on cardiac structure and function in NVAF has been reported seldomly. Meanwhile, there was a controversy on the impact of LAAO on cardiac structure and function in NVAF. Some studies showed that implantation of a left atrial appendage occluder had no significant effect on cardiac structure and function [ 8 – 11 ]. Murtaza G et al found a significant change in left atrial passive emptying fraction and left atrial expansion index after Watchman implantation, which indicated an improvement of the left atrial piping and storage function [ 10 ]. In the present study, there was no significant effect on cardiac structure and left ventricular function over a long-term follow-up after LAAO, except a statistically significant difference for LAAD at 6months post-procedure, which was in line with the previous reports [ 8 , 11 ]. However, the statistically significant difference for LAAD was not noted in simple LAAO group but noted in combined group at 6 months post- procedure. Therefore, most of the effect to LAAD at 6 months appeared to result from ablation but not LAAO, which was consistent with J Yang et al [ 16 ]. NT-proBNP, a proteolytic precursor with no chemical activity, has a higher sensitivity and half-life than BNP. It was found that there was a significant increase of the ANP and BNP levels immediately after LAAO and decrease at 24 hours post- procedure. 19 A study published by Lakkireddy et al showed an immediate increase in NT-proBNP and BNP after LAAO, returning to baseline at 24 h and 3 months [ 20 ]. In this study, there was a significantly decreased of NT-proBNP levels in total patients and the simple LAAO group at 3 months, 6 month, and 12 months after LAAO, which was consistent with Majunke et al [ 18 ]. One possible explanation for the decrease of NT-proBNP post- procedure may be that the ANP and BNP were increased temporarily by the distraction stimulation of LAA during procedure and decreased due to the decreased secretion of ANP after LAAO. With the gradual endothelialization of the occluder, the secretion of LAA was gradually decreasing and the level of plasma ANP and BNP was decreased further. So far, the combination of LAAO for stroke prevention and RFCA or Cryo for AF symptoms control was performed and the safety and feasibility were assessed. The first study on a combined procedure was performed by Swaans et al [ 21 ]. According to this study, the safety and effectiveness of the combined procedure were confirmed. In addition, the safety and effectiveness of the combined procedure were also confirmed by the first study of the combined Cryo procedure by Fassini et al [ 22 ]. In our study, instant PVI with complete LAAO was performed in combined group. Meanwhile, there was statistically significant improvements in cardiac structure and function at 3, 6 and 12 months post- procedure in combined group, whereas the procedure –related complications including DRT, stroke and bleeding events were not significantly different from simple LAAO group. Our evidence confirmed the safety and efficacy of the combined procedure and indicated greater benefits could be expected by combined procedure in NVAF patients with clear indications. Of note, in our study, the occurrence of residual flow in combined group was higher than that in simple LAAO group during the follow-up. We hypothesized that a mismatch between LAA and the device due to the oedema of pulmonary vein crest after ablation may contribute to this occurrence, which indicated a larger more Watchman device should be selected as the suitable size in the consideration of an oversizing by 4 mm–6 mm of the diameter of the LAA. In conclusion, the main findings in our study are as following: (1) LAAO has no significant effect on cardiac structure and left ventricular function over a long-term follow-up but can significantly reduce the plasma NT-proBNP; (2) LAAO combined with ablation can significantly improve the cardiac structure and function in patients with NVAF. The improvement of cardiac structure and function comes from the influence of ablation, but not LAAO. Study limitations We acknowledge some limitations in the present study. Firstly, the study is a single-center follow-up study with a small sample size and inconsistent selection of patients at each time point, which may be biased and affect the accuracy of the study. Secondly, there are few parameters selected in the study to reflect the cardiac structure and function, and more relevant data are needed to verify the results. Thirdly, the factors such as drugs taken by patients and recurrence of AF may affect cardiac structure and function. Declarations Author contributions Zhong-bao Ruan and Li Zhu conceived the idea and designed the project. Zhong-bao Ruan, Jun-guo Zhu and Ge-cai Chen helped in experimentation and data acquisition. Fei Wang contributed to clinical evaluation and sample provision. Zhong-bao Ruan, Yi Ren and Ge-cai Chen contributed to data analysis and the interpretation of the results. Zhong-bao Ruan took the lead in writing the manuscript along Fei Wang. Li Zhu supervised the research. All authors reviewed and approved the manuscript. Funding The study was supported by Jiangsu Provincial Medical Innovation Team (Grant No. CXTDB2017015), Jiangsu Commission of Health, China (Grant No. H201665) and Taizhou Science and Technology Support Program Project (Grant No.TS202215). Data Availability The data used to support the findings of this study is available from the corresponding author upon request. Conflict of interest statement The authors have no conflicts of interest to declare. Statement of human and animal rights All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki Declaration and approved by the ethics committee of Jiangsu Taizhou People’s Hospital (KY-No. 202008001). Informed consent Informed consent was obtained from all subjects involved in the study. References Wilkinson C, Todd O, Clegg A et al (2019) Management of atrial fibrillation for older people with frailty: a systematic review and meta-analysis. Age Ageing 48:196–203. Bukhari S, Khan SZ, Bashir Z (2023) Atrial Fibrillation, Thromboembolic Risk, and Anticoagulation in Cardiac Amyloidosis: A Review. J Card Fail 29:76–86. Yilmaz MF, Acar E, Inanir M et al (2022) Serum heparanase levels and left atrial/ left atrial appendage thrombus in patients with nonvalvular atrial fibrillation. Herz. 47:251–257. Alfadhel M, Nestelberger T, Samuel R et al (2021) Left atrial appendage closure -Current status and future directions. Prog Cardiovasc Dis 69:101–109. Cook JA, Lancaster MC, Kanagasundram AN et al (2023) Left atrial appendage dimension predicts elevated brain natriuretic peptide in nonvalvular atrial fibrillation. J Cardiovasc Electrophysiol 34:135–141. Pommier T, Leclercq T, Guenancia C et al (2021) Left atrial remodeling and brain natriuretic peptide levels variation after left atrial appendage occlusion. J Clin Med 10:3443. Sarzani R, Allevi M, Di Pentima C et al (2022) Role of Cardiac Natriuretic Peptides in Heart Structure and Function. Int J Mol Sci 23:14415. Hanna IR, Kolm P, Martin R et al (2004) Left atrial structure and function after percutaneous left atrial appendage transcatheter occlusion (PLAATO): Six-month echocardiographic follow-up. J Am Coll Cardiol 43: 1868–1872. Lakkireddy D, Turagam M, Afzal MR et al (2018) Left Atrial Appendage Closure and Systemic Homeostasis: The LAA HOMEOSTASIS Study. J Am Coll Cardiol 71:135–144. Murtaza G, Vuddanda V, Akella Ket al (2020) Impact of left atrial appendage occlusion on left atrial function-The LAFIT Watchman study. J Interv Card Electrophysiol 58: 163–167. Turagam MK, Reddy VY, Dukkipati SR (2019) EWOLUTION of watchman left atrial appendage closure to patients with contraindication to oral anticoagulation. Circ Arrhythm Electrophysiol 12: E007257. Phillips KP, Pokushalov E, Romanov Av et al (2018) Combining Watchman left atrial appendage closure and catheter ablation for atrial fibrillation: multicentre registry results of feasibility and safety during implant and 30 days follow-up. Europace 20:949e55. Pasupula DK, Siddappa Malleshappa SK, Munir MB et al (2023) Combined atrial fibrillation ablation and left atrial appendage occlusion procedure in the United States: a propensity score matched analysis from 2016–2019 national readmission database. Europace 25:390–399. Hindricks G, Potpara T, Dagres N et al (2021) 2020 ESC Guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS): The Task Force for the diagnosis and management of atrial fibrillation of the European Society of Cardiology (ESC) Developed with the special contribution of the European Heart Rhythm Association (EHRA) of the ESC. Eur Heart J 42:373–498. Ding MZ, Ebeling M, Ziegler L et al (2023) Time trends in atrial fibrillation-related stroke during 2001–2020 in Sweden: a nationwide, observational study. Lancet Reg Health Eur 28:100596. Azizy O, Rammos C, Lehmann N et al (2017) Percutaneous closure of the left atrial appendage in patients with diabetes mellitus. Diab Vasc Dis Res14:407–414. January CT, Wann LS, Calkins H et al (2019) 2019 AHA/ACC/HRS Focused Update of the 2014 AHA/ACC/HRS Guideline for the management of patients with atrial fibrillation: A report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society. J Am Coll Cardiol 74:104–132. Yang J, Liu Y, Feng L et al (2021) Effect of left atrial appendage closure in combination with catheter ablation on left atrial function for persistent atrial fibrillation. Front Cardiovasc Med 8:666465. Majunke N, Sandri M, Adams V et al (2015) Atrial and brain natriuretic peptide secretion after percutaneous closure of the left atrial appendage with the watchman device. J Invasive Cardiol 27: 448–452. Lakkireddy D, Turagam M, Afzal MR et al (2018) Left atrial appendage closure and systemic homeostasis: The LAA homeostasis study. J Am Coll Cardiol 71:135–144. Wintgens L, Romanov A, Phillips K, et al (2018) Combined atrial fibrillation ablation and left atrial appendage closure:long-term follow-up from a large multicentre registry. Europace 20:1783–9. Fassini G, Conti S, Moltrasio M et al (2016) Concomitant cryoballoon ablation and percutaneous closure of left atrial appendage in patients with atrial fibrillation. Europace. 18:1705–10. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-3826129","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Article","associatedPublications":[],"authors":[{"id":265169097,"identity":"be978200-e4d7-4e09-bb32-5d0502f31039","order_by":0,"name":"Zhong-bao Ruan","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA7UlEQVRIiWNgGAWjYBAC+wY4MxHIrJCQkyekxeAAkDgA13LGwtiwAbdqdC0JDAyMbRWJUB4eLTeSnz3+8MdO3rw9ufHDz3kSCYwNzA8f3cCjxX5GmrnBAZ5kwzlnHjZL9m6TyGNnYDM2zsGjxU4iwUzigMQBxhkSiQ3SjNskihkbeNik8Wkxlkj/JnHA4IA9UEvzb8Y5QI0HCGgxnJEDtCXhQCJQS5s0YwMRWgzOvCmTOHMgOXkGz8M2y55jEsaGzQT8YnA8fZtExR872xns6Y9v/Kipk5Nnb374GJ8WLICZNOWjYBSMglEwCrAAAJdRTv1ed4prAAAAAElFTkSuQmCC","orcid":"","institution":"the affiliated Taizhou People's Hospital of Nanjing Medical University, Nanjing Medical University","correspondingAuthor":true,"submittingAuthor":false,"prefix":"","firstName":"Zhong-bao","middleName":"","lastName":"Ruan","suffix":""},{"id":265169098,"identity":"781ca245-5544-46f7-b855-6075842e6d68","order_by":1,"name":"Fei Wang","email":"","orcid":"","institution":"the affiliated Taizhou People's Hospital of Nanjing Medical University, Nanjing Medical University","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Fei","middleName":"","lastName":"Wang","suffix":""},{"id":265169099,"identity":"61320364-33e6-456d-900e-90867cd07ca4","order_by":2,"name":"Ge-cai Chen","email":"","orcid":"","institution":"the affiliated Taizhou People's Hospital of Nanjing Medical University, Nanjing Medical University","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Ge-cai","middleName":"","lastName":"Chen","suffix":""},{"id":265169100,"identity":"eaad0d53-8b03-4f36-9c11-3e575c2d8326","order_by":3,"name":"Jun-guo Zhu","email":"","orcid":"","institution":"the affiliated Taizhou People's Hospital of Nanjing Medical University, Nanjing Medical University","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Jun-guo","middleName":"","lastName":"Zhu","suffix":""},{"id":265169101,"identity":"33eea97a-c9a8-4b92-8003-a0b09c28d077","order_by":4,"name":"Yin Ren","email":"","orcid":"","institution":"the affiliated Taizhou People's Hospital of Nanjing Medical University, Nanjing Medical University","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Yin","middleName":"","lastName":"Ren","suffix":""},{"id":265169102,"identity":"8405d7c4-925e-4d81-9cb2-d664c954a4c7","order_by":5,"name":"Li Zhu","email":"","orcid":"","institution":"the affiliated Taizhou People's Hospital of Nanjing Medical University, Nanjing Medical University","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Li","middleName":"","lastName":"Zhu","suffix":""}],"badges":[],"createdAt":"2023-12-31 15:44:12","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-3826129/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-3826129/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":49240356,"identity":"56f19302-625f-4d10-be7e-173a0fc8957c","added_by":"auto","created_at":"2024-01-05 18:21:21","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":145937,"visible":true,"origin":"","legend":"\u003cp\u003eFlowchart of the study procedure. LAAO: left atrial appendage occlusion, Cryo: cryoballoon ablation, RFCA: radiofrequency catheter ablation, TEE: transesophageal echocardiography, NT-proBNP: n-terminal pro-brain natriuretic peptide.\u003c/p\u003e","description":"","filename":"Figure1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-3826129/v1/02dad21b65c3d0bab5f3cfad.jpg"},{"id":50414304,"identity":"e42a8859-52ca-4a15-a5a4-524fdf55e138","added_by":"auto","created_at":"2024-01-31 07:52:32","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":523971,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-3826129/v1/f911f622-64f2-4571-a3fe-1761a6b4b192.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Comparison of cardiac function and structure after left atrial appendage occlusion without versus with ablation in patients with non-valvular atrial fibrillation: a retrospective study","fulltext":[{"header":"Introduction","content":"\u003cp\u003eAtrial fibrillation (AF) is one of the most common arrhythmias and the incidence increases with age [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Thromboembolic complication is the leading cause of death and disability in patients with AF [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Studies have shown that left atrial appendage (LAA) is the main cardioembolic site in non-valvular atrial fibrillation (NVAF) [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Left atrial appendage occlusion (LAAO) has now been shown to be a safety and effective alternative therapy to oral anticoagulation (OAC) for preventing stroke in NVAF patients with high-risk [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. Emerging evidence indicates that LAA is a contractile and compliant organ that involves in the regulation of pressures in the left atrium and plays an important role in the preservation of left ventricular filling. Meanwhile, it is one of the major hormone-producing sites, involves in neurohormonal secretion such as brain natriuretic peptide (BNP) and atrial natriuretic peptide (ANP) [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e], which can affect cardiac function and structure and prevent the development and progression of heart failure (HF) [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eRegarding the physiology role of the LAA, whether occlusion of the LAA may have any deleterious effects on the human body are still unclear to medical science so far. There are several reports provided inconsistent results about the impact of LAAO on cardiac function and structure in NVAF patients [\u003cspan additionalcitationids=\"CR9 CR10\" citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. Therefore, in this study, we aimed to investigate the effect of LAAO on cardiac structure and function in patients with NVAF through long term follow-up after LAAO. Moreover, the combination strategy of LAAO for stroke prevention and catheter ablation for AF symptoms controlling was proposed and the feasibility and safety were proven [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. However, the effect of combination therapy on cardiac function and structure has not been investigated. Therefore, the impact of combination therapy on cardiac function and structure were investigated at the same time. Meanwhile, comparison of cardiac function and structure after LAAO without versus with ablation in patients with NVAF was perfprmed.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy population\u003c/h2\u003e \u003cp\u003eThis study included 157 patients with NVAF who underwent Watchman LAAO or combined with radiofrequency catheter ablation (RFCA) / cryoballoon ablation (Cryo) at Jiangsu Taizhou People's Hospital from March 2018 to November 2020, and the diagnosis of NVAF was mainly based on the criteria listed in the 2020 ESC Guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS) [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. All patients met the inclusion criteria: ① definite diagnosis of NVAF refractory to antiarrhythmic drugs; ② Age\u0026thinsp;\u0026ge;\u0026thinsp;18 years; ③ CHA2DS2-VASc score\u0026thinsp;\u0026ge;\u0026thinsp;2 (male) or \u0026ge;\u0026thinsp;3 (female); ④ Intolerant or unwilling to long-term anticoagulant therapy or contraindicated with anticoagulant drugs; The exclusion criteria were as follows: ① Transesophageal echocardiography (TEE) or CT angiography (CTA) showed thrombus in left atrium or LAA before operation; ② left atrial anteroposterior diameter (LAAD)\u0026thinsp;\u0026gt;\u0026thinsp;65 mm for LAAO or \u0026gt;\u0026thinsp;55 mm for radiofrequency ablation/cryoablation; ③ LAA ostium\u0026thinsp;\u0026lt;\u0026thinsp;17 mm or \u0026gt;\u0026thinsp;31 mm; ④ patients with rheumatic or valvular heart disease; ⑤ history of stroke within 1 month; ⑥cardiac function class IV (NYHA class New York); ⑦ inadequate control of hypertension; ⑧ coagulopathy. A total of 157 subjects were included in the study after screening. The study was approved by the hospital ethics committee and all patients signed the informed consent form.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eData Collection\u003c/h2\u003e \u003cp\u003eThe relevant laboratory tests (including routine blood tests, coagulation, biochemistry index, thyroid function and plasma N-terminal pro-brain natriuretic peptide (NT-proBNP) and routine electrocardiogram were performed preoperatively. Clinical data were collected including age, gender, body mass index (BMI) (Kg/m\u003csup\u003e2\u003c/sup\u003e), type of NVAF, New York Heart Association (NYHA) functional classification, medical history (including hypertension, diabetes mellitus, coronary artery disease, congestive heart failure/cardiac insufficiency, peripheral vascular disease, hepatic insufficiency, renal insufficiency), history of thromboembolism (including stroke/transient ischemic attack), history of hemorrhage, CHA2DS2-VASc score, HAS-BLED score, perioperative adverse events.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eTEE and CTA protocol\u003c/h2\u003e \u003cp\u003eTEE (Philips EPIQ 7C ) and CTA(Siemens 128-row SOMATOM Force, Germany) were underwent to eliminate LA A thrombus and to calculate the orifice diameter and depth of LAA before the procedure. Meanwhile, the following parameters were collected by TEE including left atrial anteroposterior diameter (LAAD), left ventricular end-diastolic dimension (LVEDD), left ventricular end-systolic dimension (LVESD) and left ventricular ejection fraction (LVEF). The TEE operator was the same at baseline and follow up.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eLAAO procedure using the Watchman2.5 device\u003c/h2\u003e \u003cp\u003eLAAO procedure was performed under deep intravenous anesthesia or general anesthesia and TEE monitoring. Following successful transseptal puncture, angiography of LAA was performed to measure the orifice diameter and depth of LAA. Based on the measured parameters on diameter and depth of LAA by TEE, CTA and digital subtraction angiography (DSA), oversizing by 4 mm\u0026ndash;6 mm of the diameter of the LAA was selected as a suitable device size. The Watchman2.5 device was released when the conditions of a proper position with no or minimal (\u0026lt;\u0026thinsp;5 mm) residual flow and a safety tug test were met by DSA and TEE.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003eRFCA and Cryo procedure\u003c/h2\u003e \u003cp\u003eIn combined group, RFCA or Cryo was performed before LAAO. RFCA was used in 65 patients with persistent or paroxysmal atrial fibrillation. The left atrium and pulmonary vein models were constructed with CARTO three-dimensional mapping system (CARTO R 3; Biosense Webster, Irvine, CA, USA), pulmonary vein isolation (PVI) was performed in all patients with Coolflex catheters. For persistent atrial fibrillation, left atrial substrate mapping and homogenous ablation of low voltage areas were performed. Cryo was used in 21 patients with paroxysmal atrial fibrillation. A 28mm diameter of second generation cryoballoon (Arctie Front @ Cryoablation Catheter, Medtronic Inc., USA) was used for the purpose of PVI.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003ePost-procedural anticoagulation\u003c/h2\u003e \u003cp\u003eThe therapy of anticoagulation combiner with antiplatelet was recommended for 3 months following the procedure. Antiarrhythmic drugs were also used for 3 months in patients with combined procedure. Dual antiplatelet therapy with aspirin and clopidogrel was recommended for another 3 months if there were neither thromboembolism nor persistent peri-device leaks more than 5 mm detected by TEE follow-up. Then aspirin or clopidogrel was recommended indefinitely.\u003c/p\u003e \u003cdiv id=\"Sec9\" class=\"Section3\"\u003e \u003ch2\u003eFollow-up\u003c/h2\u003e \u003cp\u003ePatients were followed up at 3 months, 6 months and 12 months post- procedure. During the follow-up, adverse events including thromboembolic events, bleeding events and mortality etc were recorded. TEE was performed and the plasma NT-proBNP was measured to evaluate the changes of cardiac function and structure. Residual leak and device-related thrombus (DRT) formation were also assessed by TEE.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec10\" class=\"Section2\"\u003e \u003ch2\u003eStatistical analysis\u003c/h2\u003e \u003cp\u003eStatistical software SPSS 26.0 was used for analysis, Kolmogorov-Smirnov test was used to test whether the data were normal distribution. The normal distribution in the measurement data was presented as mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation, and paired sample t-test is used for comparison. Categorical data were presented as counts and percent and chi-square test were applied. A p value\u0026thinsp;\u0026lt;\u0026thinsp;0.05 was considered statistically significant.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eClinical baseline characteristics\u003c/h2\u003e \u003cp\u003ePatient disposition was summarized in Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e. In this study, of the 157 patients, 76 underwent LAAO only (Simple LAAO group) and 81 underwent LAAO alongside ablation (Combined group). The mean age was 67.4\u0026thinsp;\u0026plusmn;\u0026thinsp;8.9 years, the mean CHA\u003csub\u003e2\u003c/sub\u003eDS\u003csub\u003e2\u003c/sub\u003e-VASc score was 3.06\u0026thinsp;\u0026plusmn;\u0026thinsp;1.06 and HAS-BLED score 2.78\u0026thinsp;\u0026plusmn;\u0026thinsp;0.81. There were 109 (69.4%), 73 (46.5%), 38 (24.2%), 46 (29.3%), 35 (22.3%) and 5 (3.2%) of the patients suffering from hypertension, congestive heart failure, diabetes mellitus, prior stroke, coronary heart disease and bleeding history, respectively. The detailed clinical baseline characteristics were shown in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eBaseline characteristics of the population\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"2\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBaseline characteristics\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003en\u0026thinsp;=\u0026thinsp;157\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale, n(%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e91(58.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge(years)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e67.4\u0026thinsp;\u0026plusmn;\u0026thinsp;8.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBMI(Kg/m\u0026sup2;)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e25.0\u0026thinsp;\u0026plusmn;\u0026thinsp;3.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eParoxysmal AF, n(%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e43(27.4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePersistent AF, n(%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e114(72.6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCHA2DS2-VASc score\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3.06\u0026thinsp;\u0026plusmn;\u0026thinsp;1.06\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHAS-BLED score\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.78\u0026thinsp;\u0026plusmn;\u0026thinsp;0.81\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMedical history\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHypertension, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e109(69.4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHeart failure, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e73(46.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDiabetes mellitus, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e38(24.2)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eStroke history, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e46(29.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCoronary heart disease, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e35(22.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAbnormal liver function, n (%)\u003c/p\u003e \u003cp\u003eAbnormal rennal function, n (%)\u003c/p\u003e \u003cp\u003eHemorrhage history, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e31(19.7)\u003c/p\u003e \u003cp\u003e4(2.5)\u003c/p\u003e \u003cp\u003e5(3.2)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMedications\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAntiplatelet agents, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e35 (22.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOral anticoagulants, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e96 (61.1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWarfarin, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e27 (17.2)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNew oral anticoagulants, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e69 (43.9)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eBMI: body mass index; AF: atrial fibrillation.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cb\u003eAssessment of the periprocedural parameters\u003c/b\u003e \u003c/p\u003e \u003cp\u003eThe LAAO procedure with Watchman2.5 occluders or combined procedure was performed successfully in included patients. The LAA ostial diameter and depth measured by preoperative CTA (diameter: 23.6\u0026thinsp;\u0026plusmn;\u0026thinsp;3.7 mm, depth: 25.1\u0026thinsp;\u0026plusmn;\u0026thinsp;3.9 mm) was greater than those by TEE (diameter: 22.4\u0026thinsp;\u0026plusmn;\u0026thinsp;3.6 mm, depth: 23.8\u0026thinsp;\u0026plusmn;\u0026thinsp;3.6 mm) and DSA (diameter: 22.9\u0026thinsp;\u0026plusmn;\u0026thinsp;3.7 mm, depth: 24.6\u0026thinsp;\u0026plusmn;\u0026thinsp;3.7 mm). There were 11 (7.0%), 28 (17.8%), 49(31.2%), 30 (19.1%) and 39(24.8%) of all Watchman2.5 devices for 21 mm, 24 mm, 27 mm, 30 mm and 33 mm, respectively. There were 129 (82.2%) patients without no residual leak, 24 (15.3%) patients with residual leak less than 3 mm, 4 (2.5%) patients with residual leak between 3 mm and 5 mm. After LAAO, shoulder exposure was happened in 31 cases (19.7%) and the mean compression ratio was (21.6\u0026thinsp;\u0026plusmn;\u0026thinsp;4.6) %. There were 10 (6.4%) cases with complications, in which, cardiac tamponade was found in 2 (1.3%)cases during and after the operation, micropericardial effusion was occurred in 5 (3.2%) cases. Detailed data were present in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eThe periprocedural parameters\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"2\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePeriprocedural parameters\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003en\u0026thinsp;=\u0026thinsp;157\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eProcedure method\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCryo\u0026thinsp;+\u0026thinsp;LAAO\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e51(32.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRFCA\u0026thinsp;+\u0026thinsp;LAAO\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e30(19.1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLAAC\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e76(48.4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDevice size\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e21mm, n(%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e11(7.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e24mm, n(%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e28(17.8)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e27mm, n(%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e49(31.2)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e30mm, n(%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e30(19.1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e33mm, n(%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e39(24.8)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLAA orifice diameter (mm)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCTA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e23.6\u0026thinsp;\u0026plusmn;\u0026thinsp;3.7**\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTEE\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e22.4\u0026thinsp;\u0026plusmn;\u0026thinsp;3.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDSA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e22.9\u0026thinsp;\u0026plusmn;\u0026thinsp;3.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLAA length (mm)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCTA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e25.1\u0026thinsp;\u0026plusmn;\u0026thinsp;3.9**\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTEE\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e23.8\u0026thinsp;\u0026plusmn;\u0026thinsp;3.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDSA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e24.6\u0026thinsp;\u0026plusmn;\u0026thinsp;3.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eResidual flow\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e0mm, n(%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e129(82.2)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003c3mm, n(%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e24(15.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3-5mm, n(%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4(2.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;5mm, n(%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eExposure shoulder of occluders\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes, n(%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e31(19.7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo, n(%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e126(80.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCompression ratio of occluder(%, \u0026oline;x\u0026thinsp;\u0026plusmn;\u0026thinsp;s)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e21.6\u0026thinsp;\u0026plusmn;\u0026thinsp;4.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eComplications\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e10((6.4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePericardial effusion, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5(3.2)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCardiac tamponade, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2(1.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVagal reflex, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2(1.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePhrenic nerve palsy, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1(0.65)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"2\"\u003eCryo: Cryoballoon ablation; LAAC: Left atrial appendage occlusion; RFCA: Radiofrequency catheter ablation; LAA: Left atrial appendage; CTA: CT angiography ; TEE: transesophageal echocardiography;DSA: Digital subtraction angiograph.** Compared with TEE, p\u0026thinsp;\u0026lt;\u0026thinsp;0.01.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003eImpact of LAAO or combined with ablation on cardiac function and structure\u003c/h2\u003e \u003cp\u003eAs shown in Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e, there were 157 patients, 122 patients and 81 patients completed the follow-up at 3 months, 6 months and 12 months, respectively. There was a significant decrease of LAAD at 6 months. Meanwhile, a significant increase of LVEDD was seen at 12 months after LAAO. No significant impact was indicated in LVESD and LVEF. However, the LAAO therapy was associated with a significant decrease in plasma NT-proBNP level at 3 months, 6 months and 12 months after operation.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eEvolution of cardiac function after procedure\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eLAAD\u003c/p\u003e \u003cp\u003e(mm)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eLVEDD\u003c/p\u003e \u003cp\u003e(mm)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eLVESD\u003c/p\u003e \u003cp\u003e(mm)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eLVEF\u003c/p\u003e \u003cp\u003e(%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eNT-proBNP\u003c/p\u003e \u003cp\u003e(pg/ml)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e3 months\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;157)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBaseline\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e48.22\u0026thinsp;\u0026plusmn;\u0026thinsp;6.74\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e50.46\u0026thinsp;\u0026plusmn;\u0026thinsp;5.84\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e33.59\u0026thinsp;\u0026plusmn;\u0026thinsp;6.31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e61.75\u0026thinsp;\u0026plusmn;\u0026thinsp;9.41\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1154.30\u0026thinsp;\u0026plusmn;\u0026thinsp;678.90\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePost-procedure\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e47.82\u0026thinsp;\u0026plusmn;\u0026thinsp;6.55\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e50.51\u0026thinsp;\u0026plusmn;\u0026thinsp;5.17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e33.48\u0026thinsp;\u0026plusmn;\u0026thinsp;5.64\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e62.16\u0026thinsp;\u0026plusmn;\u0026thinsp;9.22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e987.30\u0026thinsp;\u0026plusmn;\u0026thinsp;514.10\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003et value\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.533\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.081\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.163\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.391\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e2.456\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ep value\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.125\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.994\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.991\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.338\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.019\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e6 months\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;122)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBaseline\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e48.34\u0026thinsp;\u0026plusmn;\u0026thinsp;6.71\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e50.63\u0026thinsp;\u0026plusmn;\u0026thinsp;5.63\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e33.56\u0026thinsp;\u0026plusmn;\u0026thinsp;6.32\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e62.24\u0026thinsp;\u0026plusmn;\u0026thinsp;9.63\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1314.36\u0026thinsp;\u0026plusmn;\u0026thinsp;698.95\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePost-procedure\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e46.48\u0026thinsp;\u0026plusmn;\u0026thinsp;7.07\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e50.75\u0026thinsp;\u0026plusmn;\u0026thinsp;5.38\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e33.16\u0026thinsp;\u0026plusmn;\u0026thinsp;5.80\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e61.75\u0026thinsp;\u0026plusmn;\u0026thinsp;9.06\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1127.50\u0026thinsp;\u0026plusmn;\u0026thinsp;651.90\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003et value\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.113\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.171\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.515\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.409\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e2.159\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ep value\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.041\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.533\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.230\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.489\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.036\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e12 months\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;81)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBaseline\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e47.75\u0026thinsp;\u0026plusmn;\u0026thinsp;6.56\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e50.16\u0026thinsp;\u0026plusmn;\u0026thinsp;4.82\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e32.83\u0026thinsp;\u0026plusmn;\u0026thinsp;5.67\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e62.96\u0026thinsp;\u0026plusmn;\u0026thinsp;8.79\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1255.00\u0026thinsp;\u0026plusmn;\u0026thinsp;791.31\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePost-procedure\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e47.25\u0026thinsp;\u0026plusmn;\u0026thinsp;6.79\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e51.30\u0026thinsp;\u0026plusmn;\u0026thinsp;4.52\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e33.49\u0026thinsp;\u0026plusmn;\u0026thinsp;4.83\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e62.23\u0026thinsp;\u0026plusmn;\u0026thinsp;9.20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e987.00\u0026thinsp;\u0026plusmn;\u0026thinsp;572.40\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003et value\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.476\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.553\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.797\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.516\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e2.471\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ep value\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.107\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.013\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.121\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.444\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.023\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"7\"\u003eLAAD: left atrial anteroposterior diameter; LVEDD: left ventricular end-diastolic dimension; LVESD: left ventricular end-systolic dimension; LVEF: left ventricular ejection fraction; NT-proBNP: N-terminal pro-brain natriuretic peptide.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cb\u003eComparison of the influence on cardiac function and structure between Simple LAAO group and Combined group\u003c/b\u003e \u003c/p\u003e \u003cp\u003ePatients were divided into Simple LAAO group and Combined group according to the procedural approach. Instant PVI with complete LAAO was achieved in combined group. There were 76 patients, 62 patients and 39 patients in simple LAAO group at 3 months, 6 months and 12 months after procedure, while 81 patients, 60 patients and 42 patients in combined group, respectively. Results showed that there was a significant decrease of NT-proBNP levels at 6 months and 12 months after operation in the Simple LAAO group, but not show at 3 months. Meanwhile, no significant change of LAAD, LVEDD, LVESD and LVEF was noted in Simple LAAO group during the 3months, 6 months and 12 months follow-up. However, compared with the baseline, there was significant improvement of LAAD, LVEDD, LVESD, LVEF, NT-proBNP in Combined group at the follow-up periods of 3 months, 6 months, and 12 months. The detailed results were listed in Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e, Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e and Table\u0026nbsp;\u003cspan refid=\"Tab6\" class=\"InternalRef\"\u003e6\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eEvolution of cardiac function of Simple LAAO group and Combined group at 3 months post- procedure\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eLAAD\u003c/p\u003e \u003cp\u003e(mm)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eLVEDD\u003c/p\u003e \u003cp\u003e(mm)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eLVESD\u003c/p\u003e \u003cp\u003e(mm)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eLVEF\u003c/p\u003e \u003cp\u003e(%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eNT-proBNP\u003c/p\u003e \u003cp\u003e(pg/ml)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eSimple LAAO group(n\u0026thinsp;=\u0026thinsp;76)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBaseline\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e51.37\u0026thinsp;\u0026plusmn;\u0026thinsp;6.40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e51.58\u0026thinsp;\u0026plusmn;\u0026thinsp;6.40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e34.66\u0026thinsp;\u0026plusmn;\u0026thinsp;7.07\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e61.00\u0026thinsp;\u0026plusmn;\u0026thinsp;10.78\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1315.40\u0026thinsp;\u0026plusmn;\u0026thinsp;919.18\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePost-procedure\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e50.91\u0026thinsp;\u0026plusmn;\u0026thinsp;6.56\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e51.33\u0026thinsp;\u0026plusmn;\u0026thinsp;5.58\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e34.46\u0026thinsp;\u0026plusmn;\u0026thinsp;6.33\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e61.29\u0026thinsp;\u0026plusmn;\u0026thinsp;10.17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1160.60\u0026thinsp;\u0026plusmn;\u0026thinsp;777.75\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003et value\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.438\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.257\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.184\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.172\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1.122\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ep value\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.214\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.393\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.748\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.923\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.119\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eCombined group(n\u0026thinsp;=\u0026thinsp;81)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBaseline\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e45.26\u0026thinsp;\u0026plusmn;\u0026thinsp;4.59\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e50.34\u0026thinsp;\u0026plusmn;\u0026thinsp;4.48\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e34.42\u0026thinsp;\u0026plusmn;\u0026thinsp;3.87\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e60.58\u0026thinsp;\u0026plusmn;\u0026thinsp;7.89\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1003.00\u0026thinsp;\u0026plusmn;\u0026thinsp;499.00\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePost-procedure\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e42.98\u0026thinsp;\u0026plusmn;\u0026thinsp;4.56\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e47.86\u0026thinsp;\u0026plusmn;\u0026thinsp;4.74\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e32.09\u0026thinsp;\u0026plusmn;\u0026thinsp;3.65\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e64.52\u0026thinsp;\u0026plusmn;\u0026thinsp;6.59\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e689.30\u0026thinsp;\u0026plusmn;\u0026thinsp;378.65\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003et value\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7.111\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5.297\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e6.974\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-6.506\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e4.507\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ep value\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"7\"\u003eLAAO:left artial appendage occlusion; LAAD: left atrial anteroposterior diameter; LVEDD: left ventricular end-diastolic dimension; LVESD: left ventricular end-systolic dimension; LVEF: left ventricular ejection fraction ; NT-proBNP: N-terminal pro-brain natriuretic peptide.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eEvolution of cardiac function of Simple LAAO group and Combined group at 6 months post- procedure\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eLAAD\u003c/p\u003e \u003cp\u003e(mm)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eLVEDD\u003c/p\u003e \u003cp\u003e(mm)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eLVESD\u003c/p\u003e \u003cp\u003e(mm)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eLVEF\u003c/p\u003e \u003cp\u003e(%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eNT-proBNP\u003c/p\u003e \u003cp\u003e(pg/ml)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eSimple LAAO group(n\u0026thinsp;=\u0026thinsp;62)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBaseline\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e51.06\u0026thinsp;\u0026plusmn;\u0026thinsp;6.29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e51.21\u0026thinsp;\u0026plusmn;\u0026thinsp;6.16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e34.27\u0026thinsp;\u0026plusmn;\u0026thinsp;7.06\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e61.47\u0026thinsp;\u0026plusmn;\u0026thinsp;11.04\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1438.50\u0026thinsp;\u0026plusmn;\u0026thinsp;939.33\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePost-procedure\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e50.21\u0026thinsp;\u0026plusmn;\u0026thinsp;7.37\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e50.18\u0026thinsp;\u0026plusmn;\u0026thinsp;5.71\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e34.48\u0026thinsp;\u0026plusmn;\u0026thinsp;6.27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e60.06\u0026thinsp;\u0026plusmn;\u0026thinsp;10.19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e949.84\u0026thinsp;\u0026plusmn;\u0026thinsp;796.50\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003et value\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.691\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.965\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.158\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.742\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e3.124\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ep value\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.646\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.193\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.888\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.672\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.016\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eCombined group(n\u0026thinsp;=\u0026thinsp;60)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBaseline\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e45.06\u0026thinsp;\u0026plusmn;\u0026thinsp;4.23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e50.25\u0026thinsp;\u0026plusmn;\u0026thinsp;4.41\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e33.93\u0026thinsp;\u0026plusmn;\u0026thinsp;3.82\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e60.22\u0026thinsp;\u0026plusmn;\u0026thinsp;7.52\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1177.26\u0026thinsp;\u0026plusmn;\u0026thinsp;657.23\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePost-procedure\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e42.55\u0026thinsp;\u0026plusmn;\u0026thinsp;4.28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e47.73\u0026thinsp;\u0026plusmn;\u0026thinsp;5.74\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e31.95\u0026thinsp;\u0026plusmn;\u0026thinsp;3.65\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e63.41\u0026thinsp;\u0026plusmn;\u0026thinsp;8.91\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e877.15\u0026thinsp;\u0026plusmn;\u0026thinsp;510.53\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003et value\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5.145\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3.972\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e5.102\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-3.241\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e2.793\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ep value\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.002\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.032\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"7\"\u003eLAAO:left artial appendage occlusion; LAAD: left atrial anteroposterior diameter; LVEDD: left ventricular end-diastolic dimension; LVESD: left ventricular end-systolic dimension; LVEF: left ventricular ejection fraction ; NT-proBNP: N-terminal pro-brain natriuretic peptide.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab6\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 6\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eEvolution of cardiac function of Simple LAAO group and Combined group at 12 months post- procedure\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eLAAD\u003c/p\u003e \u003cp\u003e(mm)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eLVEDD\u003c/p\u003e \u003cp\u003e(mm)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eLVESD\u003c/p\u003e \u003cp\u003e(mm)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eLVEF\u003c/p\u003e \u003cp\u003e(%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eNT-proBNP\u003c/p\u003e \u003cp\u003e(pg/ml)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eSimple LAAO group(n\u0026thinsp;=\u0026thinsp;39)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBaseline\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e50.62\u0026thinsp;\u0026plusmn;\u0026thinsp;5.95\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e51.59\u0026thinsp;\u0026plusmn;\u0026thinsp;5.07\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e34.33\u0026thinsp;\u0026plusmn;\u0026thinsp;6.38\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e61.33\u0026thinsp;\u0026plusmn;\u0026thinsp;9.92\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1379.00\u0026thinsp;\u0026plusmn;\u0026thinsp;884.65\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePost-procedure\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e50.59\u0026thinsp;\u0026plusmn;\u0026thinsp;6.05\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e52.51\u0026thinsp;\u0026plusmn;\u0026thinsp;4.58\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e34.51\u0026thinsp;\u0026plusmn;\u0026thinsp;4.99\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e60.21\u0026thinsp;\u0026plusmn;\u0026thinsp;8.90\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e989.40\u0026thinsp;\u0026plusmn;\u0026thinsp;693.58\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003et value\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.221\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.840\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.139\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.525\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e2.164\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ep value\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.955\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.120\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.812\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.208\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.042\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eCombined group(n\u0026thinsp;=\u0026thinsp;42)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBaseline\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e45.14\u0026thinsp;\u0026plusmn;\u0026thinsp;4.31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e50.54\u0026thinsp;\u0026plusmn;\u0026thinsp;4.51\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e34.29\u0026thinsp;\u0026plusmn;\u0026thinsp;3.63\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e60.19\u0026thinsp;\u0026plusmn;\u0026thinsp;7.68\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1110.50\u0026thinsp;\u0026plusmn;\u0026thinsp;695.48\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePost-procedure\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e42.69\u0026thinsp;\u0026plusmn;\u0026thinsp;4.63\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e48.33\u0026thinsp;\u0026plusmn;\u0026thinsp;5.71\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e32.33\u0026thinsp;\u0026plusmn;\u0026thinsp;4.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e64.14\u0026thinsp;\u0026plusmn;\u0026thinsp;10.06\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e739.50\u0026thinsp;\u0026plusmn;\u0026thinsp;425.68\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003et value\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3.884\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.943\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3.845\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-3.23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e2.949\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ep value\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.005\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.002\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.005\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"7\"\u003eLAAO:left artial appendage occlusion; LAAD: left atrial anteroposterior diameter; LVEDD: left ventricular end-diastolic dimension; LVESD: left ventricular end-systolic dimension; LVEF: left ventricular ejection fraction ; NT-proBNP: N-terminal pro-brain natriuretic peptide.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003eProcedure-related complications in follow-up\u003c/h2\u003e \u003cp\u003eThe Watchman devices of all patients were in place. There were 129 (82.2%) patients, 97 (79.5%) patients and 65 (80.2%) patients wtithout residual flow at 3 momths, 6 months and 12 months, while residual flow less than 3 mm were 24 (15.3%) patients, 21(17.2%) patients and 13 (16.1%) patients, respectively. Compared with simple LAAO group, combined group was associated with a significant decrease of no residual flow and increase of residual flow less than 3 mm (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05) at the follow-up of 3 momths, 6 months and 12 months. Device-related thrombus was happened in 7 (4.9%) patients, 2 (1.6%) patients and 3 (3.7%) patients at 3 momths, 6 months and 12 months after procedure. Correspondingly, 2 (1.3%) cases, 1 (0.8%) case and 2 (2.5%) cases of stroke were noted, respectively. Bleeding complication was observed in 5 cases at 3 months after operation, including 1 case of gastrointestinal hemorrhage, 1 case of hemoptysis, 1 case of urinary system hemorrhage and 2 cases of skin ecchymosis. At 6 months after operation, hemorrhagic complication was occurred in 3 cases, 1 with gastrointestinal hemorrhage and 2 with ecchymosis. At 12 months, gastrointestinal bleeding occurred in 2 cases. 1 case of death occurred at 8 months post- procedure due to sudden cardiac death. Except the Incidence rate of residual flow, there was no significant diference of the procedure-related complications between simple LAAO group and combined group. The results were displayed in Table\u0026nbsp;\u003cspan refid=\"Tab7\" class=\"InternalRef\"\u003e7\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab7\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 7\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eFollow-up outcomes\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3 months(n\u0026thinsp;=\u0026thinsp;157)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6 months(n\u0026thinsp;=\u0026thinsp;122)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e12 months(n\u0026thinsp;=\u0026thinsp;81)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOccluder displace, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0(0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0(0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0(0.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eResidual flow, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e0mm\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e129(82.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e97(79.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e65(80.2)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSimple LAAO group\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e68(89.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e54(87.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e35(89.7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCombined group\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e61(75.3) *\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e43(71.7) *\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e30(71.4) *\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003c3mm\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e24(15.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e21(17.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e13(16.1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSimple LAAO group\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6(7.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6(9.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3(7.7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCombined group\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e18(22.2)*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e15(25.0)*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e10(23.8)*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3-5mm\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4(2.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4(3.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3(3.7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSimple LAAO group\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2(2.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2(3.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1(2.6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCombined group\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2(2.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2(3.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2(4.8)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;5mm\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0(0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0(0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0(0.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSimple LAAO group\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0(0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0(0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0(0.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCombined group\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0(0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0(0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0(0.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDevice-related thrombus\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7(4.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2(1.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3(3.7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSimple LAAO group\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3(3.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1(1.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2(5.1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCombined group\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4(4.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1(1.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1(2.4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eStroke\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2(1.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1(0.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2(2.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSimple LAAO group\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1(1.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1(1.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1(2.6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCombined group\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1(1.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0(0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1(2.4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBleeding\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5(3.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3(2.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2(2.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSimple LAAO group\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3(3.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1(1.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1(2.6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCombined group\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2(2.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2(3.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1(2.4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDeath\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0(0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0(0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1(1.2)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSimple LAAO group\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0(0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0(0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1(2.6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCombined group\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0(0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0(0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0(0.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePost procedure medications\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWarfarin\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e24(15.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0(0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1(1.2)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDabigatran\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e106(67.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1(0.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0(0.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRivaroxaban\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e27(17.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1(0.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2(2.4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAspirin\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e126(80.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e109(89.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e69(85.2)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eClopidogrel\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e31(19.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e122(100)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e12(14.8)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"4\"\u003eLAAO:left artial appendage occlusion. *Compared with Simple LAAO group, p\u0026thinsp;\u0026lt;\u0026thinsp;0.05.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eAt present, the complication of thromboembolism is the leading cause of death and disability in AF, ischemic stroke due to AF accounts for 20% of all strokes [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. It was proven that NVAF-related thrombus was 100% from LAA [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. As a safe and effective therapy of stroke prevention, LAAO provides a viable alternative for oral anticoagulants and has been recommended for the prevention of AF stroke by the guidelines [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eHowever, the impact of LAAO on cardiac structure and function in NVAF has been reported seldomly. Meanwhile, there was a controversy on the impact of LAAO on cardiac structure and function in NVAF. Some studies showed that implantation of a left atrial appendage occluder had no significant effect on cardiac structure and function [\u003cspan additionalcitationids=\"CR9 CR10\" citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. Murtaza G et al found a significant change in left atrial passive emptying fraction and left atrial expansion index after Watchman implantation, which indicated an improvement of the left atrial piping and storage function [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. In the present study, there was no significant effect on cardiac structure and left ventricular function over a long-term follow-up after LAAO, except a statistically significant difference for LAAD at 6months post-procedure, which was in line with the previous reports [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. However, the statistically significant difference for LAAD was not noted in simple LAAO group but noted in combined group at 6 months post- procedure. Therefore, most of the effect to LAAD at 6 months appeared to result from ablation but not LAAO, which was consistent with J Yang et al [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eNT-proBNP, a proteolytic precursor with no chemical activity, has a higher sensitivity and half-life than BNP. It was found that there was a significant increase of the ANP and BNP levels immediately after LAAO and decrease at 24 hours post- procedure. \u003csup\u003e19\u003c/sup\u003eA study published by Lakkireddy et al showed an immediate increase in NT-proBNP and BNP after LAAO, returning to baseline at 24 h and 3 months [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. In this study, there was a significantly decreased of NT-proBNP levels in total patients and the simple LAAO group at 3 months, 6 month, and 12 months after LAAO, which was consistent with Majunke et al [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. One possible explanation for the decrease of NT-proBNP post- procedure may be that the ANP and BNP were increased temporarily by the distraction stimulation of LAA during procedure and decreased due to the decreased secretion of ANP after LAAO. With the gradual endothelialization of the occluder, the secretion of LAA was gradually decreasing and the level of plasma ANP and BNP was decreased further.\u003c/p\u003e \u003cp\u003eSo far, the combination of LAAO for stroke prevention and RFCA or Cryo for AF symptoms control was performed and the safety and feasibility were assessed. The first study on a combined procedure was performed by Swaans et al [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. According to this study, the safety and effectiveness of the combined procedure were confirmed. In addition, the safety and effectiveness of the combined procedure were also confirmed by the first study of the combined Cryo procedure by Fassini et al [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. In our study, instant PVI with complete LAAO was performed in combined group. Meanwhile, there was statistically significant improvements in cardiac structure and function at 3, 6 and 12 months post- procedure in combined group, whereas the procedure \u0026ndash;related complications including DRT, stroke and bleeding events were not significantly different from simple LAAO group. Our evidence confirmed the safety and efficacy of the combined procedure and indicated greater benefits could be expected by combined procedure in NVAF patients with clear indications. Of note, in our study, the occurrence of residual flow in combined group was higher than that in simple LAAO group during the follow-up. We hypothesized that a mismatch between LAA and the device due to the oedema of pulmonary vein crest after ablation may contribute to this occurrence, which indicated a larger more Watchman device should be selected as the suitable size in the consideration of an oversizing by 4 mm\u0026ndash;6 mm of the diameter of the LAA.\u003c/p\u003e \u003cp\u003eIn conclusion, the main findings in our study are as following: (1) LAAO has no significant effect on cardiac structure and left ventricular function over a long-term follow-up but can significantly reduce the plasma NT-proBNP; (2) LAAO combined with ablation can significantly improve the cardiac structure and function in patients with NVAF. The improvement of cardiac structure and function comes from the influence of ablation, but not LAAO.\u003c/p\u003e \u003cdiv id=\"Sec16\" class=\"Section2\"\u003e \u003ch2\u003eStudy limitations\u003c/h2\u003e \u003cp\u003eWe acknowledge some limitations in the present study. Firstly, the study is a single-center follow-up study with a small sample size and inconsistent selection of patients at each time point, which may be biased and affect the accuracy of the study. Secondly, there are few parameters selected in the study to reflect the cardiac structure and function, and more relevant data are needed to verify the results. Thirdly, the factors such as drugs taken by patients and recurrence of AF may affect cardiac structure and function.\u003c/p\u003e \u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAuthor contributions\u0026nbsp;\u003c/strong\u003eZhong-bao Ruan and Li Zhu\u0026nbsp;conceived the idea and designed the project.\u0026nbsp;Zhong-bao Ruan, Jun-guo Zhu and\u0026nbsp;Ge-cai Chen\u0026nbsp;helped in experimentation and data acquisition.\u0026nbsp;Fei Wang\u0026nbsp;contributed\u0026nbsp;to clinical evaluation and sample provision.\u0026nbsp;Zhong-bao Ruan, Yi Ren and\u0026nbsp;Ge-cai Chen\u0026nbsp;contributed to data analysis and the interpretation of the results.\u0026nbsp;Zhong-bao Ruan\u0026nbsp;took the lead in writing the\u0026nbsp;manuscript along\u0026nbsp;Fei Wang.\u0026nbsp;Li Zhu\u0026nbsp;supervised the research. All authors reviewed and approved the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u0026nbsp;\u003c/strong\u003eThe study was supported by Jiangsu Provincial Medical Innovation Team (Grant No. CXTDB2017015), Jiangsu Commission of Health, China (Grant No. H201665) and\u0026nbsp;Taizhou Science and Technology Support Program Project (Grant No.TS202215).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData Availability\u0026nbsp;\u003c/strong\u003eThe data used to support the findings of this study is available from the corresponding author upon request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflict of interest statement\u0026nbsp;\u003c/strong\u003eThe authors have no conflicts of interest to declare.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStatement of human and animal rights\u003c/strong\u003e All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki Declaration and approved by the ethics committee of Jiangsu Taizhou People\u0026rsquo;s Hospital (KY-No. 202008001).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eInformed consent\u003c/strong\u003e Informed consent was obtained from all subjects involved in the study.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eWilkinson C, Todd O, Clegg A et al (2019) Management of atrial fibrillation for older people with frailty: a systematic review and meta-analysis. Age Ageing 48:196\u0026ndash;203.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBukhari S, Khan SZ, Bashir Z (2023) Atrial Fibrillation, Thromboembolic Risk, and Anticoagulation in Cardiac Amyloidosis: A Review. J Card Fail 29:76\u0026ndash;86.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eYilmaz MF, Acar E, Inanir M et al (2022) Serum heparanase levels and left atrial/ left atrial appendage thrombus in patients with nonvalvular atrial fibrillation. Herz. 47:251\u0026ndash;257.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAlfadhel M, Nestelberger T, Samuel R et al (2021) Left atrial appendage closure -Current status and future directions. Prog Cardiovasc Dis 69:101\u0026ndash;109.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCook JA, Lancaster MC, Kanagasundram AN et al (2023) Left atrial appendage dimension predicts elevated brain natriuretic peptide in nonvalvular atrial fibrillation. J Cardiovasc Electrophysiol 34:135\u0026ndash;141.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePommier T, Leclercq T, Guenancia C et al (2021) Left atrial remodeling and brain natriuretic peptide levels variation after left atrial appendage occlusion. J Clin Med 10:3443.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSarzani R, Allevi M, Di Pentima C et al (2022) Role of Cardiac Natriuretic Peptides in Heart Structure and Function. Int J Mol Sci 23:14415.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHanna IR, Kolm P, Martin R et al (2004) Left atrial structure and function after percutaneous left atrial appendage transcatheter occlusion (PLAATO): Six-month echocardiographic follow-up. J Am Coll Cardiol 43: 1868\u0026ndash;1872.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLakkireddy D, Turagam M, Afzal MR et al (2018) Left Atrial Appendage Closure and Systemic Homeostasis: The LAA HOMEOSTASIS Study. J Am Coll Cardiol 71:135\u0026ndash;144.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMurtaza G, Vuddanda V, Akella Ket al (2020) Impact of left atrial appendage occlusion on left atrial function-The LAFIT Watchman study. J Interv Card Electrophysiol 58: 163\u0026ndash;167.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTuragam MK, Reddy VY, Dukkipati SR (2019) EWOLUTION of watchman left atrial appendage closure to patients with contraindication to oral anticoagulation. Circ Arrhythm Electrophysiol 12: E007257.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePhillips KP, Pokushalov E, Romanov Av et al (2018) Combining Watchman left atrial appendage closure and catheter ablation for atrial fibrillation: multicentre registry results of feasibility and safety during implant and 30 days follow-up. Europace 20:949e55.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePasupula DK, Siddappa Malleshappa SK, Munir MB et al (2023) Combined atrial fibrillation ablation and left atrial appendage occlusion procedure in the United States: a propensity score matched analysis from 2016\u0026ndash;2019 national readmission database. Europace 25:390\u0026ndash;399.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHindricks G, Potpara T, Dagres N et al (2021) 2020 ESC Guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS): The Task Force for the diagnosis and management of atrial fibrillation of the European Society of Cardiology (ESC) Developed with the special contribution of the European Heart Rhythm Association (EHRA) of the ESC. Eur Heart J 42:373\u0026ndash;498.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDing MZ, Ebeling M, Ziegler L et al (2023) Time trends in atrial fibrillation-related stroke during 2001\u0026ndash;2020 in Sweden: a nationwide, observational study. Lancet Reg Health Eur 28:100596.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAzizy O, Rammos C, Lehmann N et al (2017) Percutaneous closure of the left atrial appendage in patients with diabetes mellitus. Diab Vasc Dis Res14:407\u0026ndash;414.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eJanuary CT, Wann LS, Calkins H et al (2019) 2019 AHA/ACC/HRS Focused Update of the 2014 AHA/ACC/HRS Guideline for the management of patients with atrial fibrillation: A report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society. J Am Coll Cardiol 74:104\u0026ndash;132.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eYang J, Liu Y, Feng L et al (2021) Effect of left atrial appendage closure in combination with catheter ablation on left atrial function for persistent atrial fibrillation. Front Cardiovasc Med 8:666465.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMajunke N, Sandri M, Adams V et al (2015) Atrial and brain natriuretic peptide secretion after percutaneous closure of the left atrial appendage with the watchman device. J Invasive Cardiol 27: 448\u0026ndash;452.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLakkireddy D, Turagam M, Afzal MR et al (2018) Left atrial appendage closure and systemic homeostasis: The LAA homeostasis study. J Am Coll Cardiol 71:135\u0026ndash;144.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWintgens L, Romanov A, Phillips K, et al (2018) Combined atrial fibrillation ablation and left atrial appendage closure:long-term follow-up from a large multicentre registry. Europace 20:1783\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFassini G, Conti S, Moltrasio M et al (2016) Concomitant cryoballoon ablation and percutaneous closure of left atrial appendage in patients with atrial fibrillation. Europace. 18:1705\u0026ndash;10.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"left atrial appendage occlusion, ablation, atrial fibrillation, cardiac structure, cardiac function","lastPublishedDoi":"10.21203/rs.3.rs-3826129/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-3826129/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eRegarding the physiology role of left atrial appendage (LAA), whether occlusion of LAA or combined with ablation has any influence on cardiac function and structure in patients with non-valvular atrial fibrillation (NVAF) is still unclear.\u003c/p\u003e\u003ch2\u003eAims\u003c/h2\u003e \u003cp\u003eTo compare the influence on cardiac function and structure after left atrial appendage occlusion (LAAO) without versus with ablation in patients with NVAF.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003e157 patients with NVAF who underwent LAAO or combined with ablation were included and divided into Simple LAAO group or Combined group. Long term impact on cardiac function and structure between the two groups were compared.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eThere was a significant decrease of left atrial anteroposterior diameter (LAAD) at 6 months and a significant increase of left ventricular end-diastolic dimension (LVEDD) at 12 months after LAAO. A significant decrease in plasma N-terminal pro-brain natriuretic peptide (NT-proBNP) was noted at 3 months, 6 months and 12 months after LAAO. Subgroup analysis indicated that there was a significant decrease of LAAD, LVEDD, LVESD and NT-proBNP levels in Combined group at 3 months, 6 months and 12 months post-procedure, while an increase of LVEF. However, no significant change of LAAD, LVEDD, LVESD, NT-proBNP and LVEF was seen in Simple LAAO group at 3 months follow-up, but a decrease of NT-proBNP during 6 months and 12 months follow-up. Compared with Simple LAAO group, Combined group was associated with a significant increase of residual flow.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eLAAO has no significant effect on cardiac structure and function but can significantly reduce NT-proBNP. The improvement of cardiac structure and function in combined therapy comes from the influence of ablation, not LAAO.\u003c/p\u003e","manuscriptTitle":"Comparison of cardiac function and structure after left atrial appendage occlusion without versus with ablation in patients with non-valvular atrial fibrillation: a retrospective study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-01-05 18:21:17","doi":"10.21203/rs.3.rs-3826129/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"4d909ea9-afac-48a4-9150-462eefe0cb9d","owner":[],"postedDate":"January 5th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":27946194,"name":"Health sciences/Cardiology"},{"id":27946195,"name":"Health sciences/Diseases"},{"id":27946196,"name":"Health sciences/Medical research"}],"tags":[],"updatedAt":"2024-01-31T07:44:25+00:00","versionOfRecord":[],"versionCreatedAt":"2024-01-05 18:21:17","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-3826129","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-3826129","identity":"rs-3826129","version":["v1"]},"buildId":"-HB7Z8yhvgn0wM9Nzuekk","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}