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Methods: We recorded direct left atrial pressure (LAP) before and after device implantation among consecutive patients undergoing LAAO from June 6, 2018 to May 25, 2023 We assessed:(a) the frequency and predictors of LAP increase post-deployment; and (b) the association between a significant LAP increase post-deployment and peridevice leak (PDL) at 45 days. Significant increase in LAP was defined as {greater than or equal to} mean LAP increase post-deployment (ie, 28%).

Results: The study included 327 patients: 36.4% female, mean age 75.8 {plus minus} 9.5, CHA2DS2-VASc score 4.7 {plus minus} 1.4, and median LA volume index 46.0 (interquartile range 36.0-57.0). Post-deployment, LAP increased in 48.0% of patients. The average increase in LAP was 27.8 {plus minus} 24.8%, and 38.0% of patients experienced an LAP increase of {greater than or equal to} 28%. Independent predictors of LAP increase post-deployment included a baseline LAP {less than or equal to} 14 mmHg, non-paroxysmal atrial fibrillation, and age (odds ratios [OR]: 3.66; 95% CI 2.21-6.05, 1.81; 95% CI 1.08-3.02, and 0.85 (per 5 years); 95% CI 0.73-0.99, respectively). Furthermore, significant increase in LAP post-deployment was an independent predictor of PDL at 45 days (OR: 2.55; 95% CI 1.04-6.26). There was no association between LAP increase post-deployment and heart failure hospitalizations.

Conclusion: LAP rises acutely in~ 50% of patients undergoing LAAO. Patients who had a significant increase in LAP were more likely to develop a PDL at 45 days. Additional studies are warranted to further explore the long-term hemodynamic effect of LAAO.