Left Atrial Appendage Morphology and Function Show an Association with Stroke and Transient Ischemic Attack in Patients with Atrial Fibrillation

Abstract BackgroundWe aimed to correlate left atrial appendage (LAA) structure and function with the history of stroke/transient ischemic attack (TIA) in patients with atrial fibrillation (AF).MethodsWe analyzed data of 649 patients with AF who were scheduled for catheter ablation. Patients underwent cardiac CT and transesophageal echocardiography prior to ablation. LAA morphologies depicted by cardiac CT were categorized into four groups: cauliflower, chicken wing, swan and windsock shapes. ResultsMean age was 61.3±10.5 years, 33.9% were female. Prevalence of stroke/TIA was 7.1%. After adjustment for the main risk factors, LAA flow velocity ≤35.3 cm/sec (OR=2.18; 95%CI=1.09-4.61; p=0.033) and swan LAA shape (OR=2.69; 95%CI=0.96-6.86; p=0.047) independently associated with higher, while windsock LAA morphology with lower risk of stroke/TIA (OR=0.32; 95%CI=0.12-0.77; p=0.017) as compared to cauliflower LAA shape. When comparing the differences between LAA morphology groups, we measured significantly smaller LAA orifice area (389.3±137.7 mm2 in windsock vs 428.3±158.9 ml in cauliflower, p=0.021) and LAA volume (7.4±3.0 mm2 in windsock vs 8.5±4.8 mm2 in cauliflower, p=0.012) in patients with windsock LAA morphology, while LAA flow velocity did not differ significantly. ConclusionReduced LAA function and swan LAA morphology were independently associated with higher, while windsock LAA shape with lower prevalence of stroke/TIA. When comparing the differences between the various LAA morphology types, significantly lower LAA volume and LAA orifice area were measured in windsock LAA shape as compared to cauliflower LAA shape.

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Comparison of Morphologic Features and Flow Velocity of the Left Atrial Appendage Among Patients With Atrial Fibrillation Alone, Transient Ischemic Attack, and Cardioembolic Stroke

The American Journal of Cardiology ◽

10.1016/j.amjcard.2017.02.016 ◽

2017 ◽

Vol 119 (10) ◽

pp. 1596-1604 ◽

Cited By ~ 9

Author(s):

Yonggu Lee ◽

Hwan-Cheol Park ◽

Youkyung Lee ◽

Soon-Gil Kim

Keyword(s):

Atrial Fibrillation ◽

Flow Velocity ◽

Transient Ischemic Attack ◽

Left Atrial ◽

Left Atrial Appendage ◽

Atrial Appendage ◽

Cardioembolic Stroke ◽

Ischemic Attack

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Left atrial appendage orifice area and morphology is closely associated with flow velocity in patients with nonvalvular atrial fibrillation

BMC Cardiovascular Disorders ◽

10.1186/s12872-021-02242-9 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Lei Chen ◽

Changjiang Xu ◽

Wensu Chen ◽

Chaoqun Zhang

Keyword(s):

Atrial Fibrillation ◽

Flow Velocity ◽

Left Atrial ◽

Left Atrial Appendage ◽

Linear Regression Analysis ◽

Left Ventricular ◽

Atrial Appendage ◽

Mechanical Function ◽

Orifice Area ◽

The Relationship

Abstract Background Thromboembolic events are the most serious complication of atrial fibrillation (AF), and the left atrial appendage (LAA) is the most important site of thrombosis in patients with AF. During the period of COVID-19, a non-invasive left atrial appendage detection method is particularly important in order to reduce the exposure of the virus. This study used CT three-dimensional reconstruction methods to explore the relationship between LAA morphology, LAA orifice area and its mechanical function in patients with non-valvular atrial fibrillation (NVAF). Methods A total of 81 consecutive patients with NVAF (36 cases of paroxysmal atrial fibrillation and 45 cases of persistent atrial fibrillation) who were planned to undergo catheter radiofrequency ablation were enrolled. All patients were examined by transthoracic echocardiography (TTE), TEE, and computed tomography angiography (CTA) before surgery. The LAA orifice area was obtained according to the images of CTA. According to the left atrial appendage morphology, it was divided into chicken wing type and non-chicken wing type. At the same time, TEE was performed to determine left atrial appendage flow velocity (LAAFV), and the relationship between the left atrial appendage orifice area and LAAFV was analyzed. Results The LAAFV in Non-chicken wing group was lower than that in Chicken wing group (36.2 ± 15.0 cm/s vs. 49.1 ± 22.0 cm/s, p-value < 0.05). In the subgroup analysis, the LAAFV in Non-chicken wing group was lower than that in Chicken wing group in the paroxysmal AF (44.0 ± 14.3 cm/s vs. 60.2 ± 22.8 cm/s, p-value < 0.05). In the persistent AF, similar results were observed (29.7 ± 12.4 cm/s vs. 40.8 ± 17.7 cm/s, p-value < 0.05). The LAAFV in persistent AF group was lower than that in paroxysmal AF group (34.6 ± 15.8 cm/s vs. 49.9 ± 20.0 cm/s, p-value < 0.001). The LAAFV was negatively correlated with left atrial dimension (R = − 0.451, p-value < 0.001), LAA orifice area (R= − 0.438, p-value < 0.001) and left ventricular mass index (LVMI) (R= − 0.624, p-value < 0.001), while it was positively correlated with LVEF (R = 0.271, p-value = 0.014). Multiple linear regression analysis showed that LAA morphology (β = − 0.335, p-value < 0.001), LAA orifice area (β = − 0.185, p-value = 0.033), AF type (β = − 0.167, p-value = 0.043) and LVMI (β = − 0.465, p-value < 0.001) were independent factors of LAAFV. Conclusions The LAA orifice area is closely related to the mechanical function of the LAA in patients with NVAF. The larger LAA orifice area and LVMI, Non-chicken wing LAA and persistent AF are independent predictors of decreased mechanical function of LAA, and these parameters might be helpful for better management of LA thrombosis.

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Combined left atrial appendage closure and ablation in a patient with hemophilia B, paroxysmal atrial fibrillation, and transient ischemic attack

HeartRhythm Case Reports ◽

10.1016/j.hrcr.2019.01.014 ◽

2019 ◽

Vol 5 (5) ◽

pp. 266-268 ◽

Cited By ~ 1

Author(s):

Zabeer Bhatti ◽

Seth Goldbarg

Keyword(s):

Atrial Fibrillation ◽

Transient Ischemic Attack ◽

Paroxysmal Atrial Fibrillation ◽

Left Atrial ◽

Left Atrial Appendage ◽

Hemophilia B ◽

Atrial Appendage ◽

Left Atrial Appendage Closure ◽

Ischemic Attack

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Electrical isolation of the left atrial appendage increases the risk of ischemic stroke and transient ischemic attack regardless of postisolation flow velocity

Heart Rhythm ◽

10.1016/j.hrthm.2018.09.012 ◽

2018 ◽

Vol 15 (12) ◽

pp. 1746-1753 ◽

Cited By ~ 38

Author(s):

Yun Gi Kim ◽

Jaemin Shim ◽

Suk-Kyu Oh ◽

Kwang-No Lee ◽

Jong-Il Choi ◽

...

Keyword(s):

Ischemic Stroke ◽

Flow Velocity ◽

Transient Ischemic Attack ◽

Left Atrial ◽

Left Atrial Appendage ◽

Atrial Appendage ◽

Electrical Isolation ◽

Ischemic Attack

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Left Atrial Appendage Orifice Area and Morphology is Closely Associated with Flow Velocity in Patients with Nonvalvular Atrial Fibrillation

10.21203/rs.3.rs-468667/v1 ◽

2021 ◽

Author(s):

Lei Chen ◽

Changjiang Xu ◽

Wensu Chen ◽

Chaoqun Zhang

Keyword(s):

Atrial Fibrillation ◽

Flow Velocity ◽

Left Atrial ◽

Left Atrial Appendage ◽

Linear Regression Analysis ◽

Atrial Appendage ◽

Mechanical Function ◽

Orifice Area ◽

Reconstruction Methods ◽

The Relationship

Abstract Background Thromboembolic events are the most serious complication of atrial fibrillation (AF), and the left atrial appendage (LAA) is the most important site of thrombosis in patients with atrial fibrillation. During the period of COVID-19, a non-invasive left atrial appendage detection method is particularly important in order to reduce the exposure of the virus. This study used CT three-dimensional reconstruction methods to explore the relationship between LAA morphology, LAA orifice area and its mechanical function in patients with non-valvular atrial fibrillation(NVAF).Methods A total of 81 consecutive patients with NVAF (36 cases of paroxysmal atrial fibrillation and 45 cases of persistent atrial fibrillation) who were planned to undergo catheter radiofrequency ablation were enrolled. All patients were examined by transthoracic echocardiography (TTE), TEE, and computed tomography angiography (CTA) before surgery. The LAA orifice area was obtained according to the images of CTA. According to the left atrial appendage morphology, it was divided into chicken wing type and non-chicken wing type. At the same time, TEE was performed to determine left atrial appendage flow velocity (LAAFV), and the relationship between the left atrial appendage orifice area and LAAFV was analyzed.Results The LAAFV in Non-chicken wing group was lower than that in Chicken wing group (36.2±15.0cm/s vs. 49.1±22.0 cm/s, P<0.05). In the subgroup analysis, the LAAFV in Non-chicken wing group was lower than that in Chicken wing group in the paroxysmal AF (44.0±14.3cm/s vs. 60.2±22.8cm/s, P<0.05); In the persistent AF, similar results were observed (29.7±12.4 cm/s vs. 40.8±17.7 cm/s, P<0.05). The LAAFV in persistent AF group was lower than that in paroxysmal AF group (34.6±15.8 cm/s vs. 49.9±20.0 cm/s, P<0.001). The LAAFV was negatively correlated with left atrial dimension (R=-0.451, P<0.001) and LAA orifice area (R=-0.438, P<0.001), while it was positively correlated with LVEF (R=0.271, P<0.001). Multiple linear regression analysis showed that LAA morphology (β=-0.319, P<0.001), LAA orifice area (β=-0.219, P=0.030), AF type ( β=-0.283, P=0.003) and left atrial diameter (LAD) (β=-0.241, P=0.018) were independent predictors of LAAFV.Conclusion The LAA orifice area is closely related to the mechanical function of the LAA in patients with NVAF. The larger LAA orifice area and LAD, Non-chicken wing LAA and persistent AF are independent predictors of decreased mechanical function of the left atrial appendage.

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Large Device-Related Thrombus Detected following Symptoms of Transient Ischemic Attack

Case Reports in Cardiology ◽

10.1155/2021/9195984 ◽

2021 ◽

Vol 2021 ◽

pp. 1-6

Author(s):

Osayi Lawani ◽

Edward Baptista

Keyword(s):

Atrial Fibrillation ◽

Transient Ischemic Attack ◽

Left Atrial ◽

Left Atrial Appendage ◽

Thrombus Formation ◽

Anticoagulation Therapy ◽

Atrial Appendage ◽

Management Options ◽

Left Atrial Appendage Occlusion ◽

Ischemic Attack

As an independent risk factor for stroke, atrial fibrillation has been shown to be associated with a fivefold increase in the cause of embolic stroke in comparison to healthy individuals without atrial fibrillation. This risk may be compounded by other factors; however, the main probable cause of stroke leading from atrial fibrillation is thrombus formation in the left atrial appendage. In patients for whom anticoagulation is contraindicated, left atrial appendage occlusion has become a leading alternative option for therapeutic prevention of thromboembolism and stroke in patients with this condition. Unfortunately, these devices (particularly the WATCHMAN) have been associated with a 3-6% incidence of intracardiac thrombus development postimplantation. Some risk factors for the development of device-related thrombus are high platelet count, permanent atrial fibrillation, resistance to clopidogrel, and prior transient ischemic attack or stroke. Despite following an anticoagulant regimen, thrombus formation was reported in 5.6% of participants of a randomized clinical trial, and further analysis showed that some of these patients continued to develop either ischemic stroke or thromboembolism five years later as compared to patients without initial thrombus development. We present a case of an elderly male with prior history of stroke and transient ischemic attack who developed a large device-related thrombus five months following WATCHMAN FLX™ implantation. Currently, there are no specific recommendations on the management of this rare complication; however, we discuss possible consideration of initially prolonging anticoagulation therapy following implantation for high-risk individuals, as there is an increased possibility for thrombus formation in this population. Management options should continue to be studied for therapeutic benefit in streamlining postprocedural therapy and improve future outcomes in the use of left atrial appendage occlusion devices, as well as continual thrombus prevention.

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Abstract WP260: The Left Atrial Appendage Morphology Improves Prediction of Appendage Stagnant Flow and Stroke Risk in Patients With Atrial Fibrillation Using a Simple Classification System

Stroke ◽

10.1161/str.51.suppl_1.wp260 ◽

2020 ◽

Vol 51 (Suppl_1) ◽

Author(s):

Shadi Yaghi ◽

Andrew Chang ◽

Gian Ignacio ◽

Erica Scher ◽

Nikhil Panda ◽

...

Keyword(s):

Atrial Fibrillation ◽

Flow Velocity ◽

Primary Endpoint ◽

Classification System ◽

Left Atrial ◽

Left Atrial Appendage ◽

Current System ◽

Classification Systems ◽

Atrial Appendage ◽

Simple Classification

Background and Purpose: Previously we proposed a simple classification system of the left atrial appendage (LAA) morphology, with low risk (LAA-L) defined as one lobe with an acute angle bend arising from the proximal or middle portion and high risk (LAA-H) defined as all other morphologies. We aim to determine the association between LAA morphology (using both classification systems), LAA flow velocity, and stroke rates. Methods: We analyzed consecutive patients with atrial fibrillation (AF) selected for ablation who underwent cardiac CT angiography and transesophageal echocardiogram. The primary correlates were LAA-H and non-chicken wing (NCW) LAA morphology. The primary outcome was the composite endpoint of history of ischemic stroke/TIA or non-lacunar infarct on neuroimaging. Adjusting for CHADS2Vasc score, multivariable models were used to determine associations between LAA morphology and composite outcomes. Results: We identified 379 patients; the primary endpoint occurred in 32/379 patients (8.4%). LAA-H (adjusted OR 3.63, 95% CI 1.44-9.14) and NCW LAA morphology (adjusted OR 2.52, 95% CI 1.15-5.53) were associated with the primary endpoint. LAA flow velocity ≤20 cm/s was more common in LAA-H vs. LAA-L (9.6% vs. 2.8%, p = 0.019), but not in NCW vs. CW LAA morphology (9.7% vs. 3.7%, p = 0.054). Conclusion: The LAA H/L morphological classification system may be superior to the current system in risk stratifying patients with AF and correlates better with impaired LAA flow dynamics.

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P4731Procedure-related acute thrombosis after surgical left atrial appendage occlusion for atrial fibrillation

European Heart Journal ◽

10.1093/eurheartj/ehz745.1107 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

T Inoue ◽

T Shimizu ◽

A Yoshimoto ◽

Y Suematsu

Keyword(s):

Atrial Fibrillation ◽

Left Atrial ◽

Cardiac Ct ◽

Left Atrial Appendage ◽

Thrombus Formation ◽

Atrial Appendage ◽

Full Cohort ◽

Exact Test ◽

Acute Thrombosis ◽

Laa Closure

Abstract Background/Introduction Left atrial appendage (LAA) occlusion is an effective strategy for thromboembolism prevention in patients with atrial fibrillation (AF), and the novel methods of occlusion is various. The acute thrombosis after percutaneous LAA occlusion devices has been recently reported, but thrombus formation after surgical LAA occlusion is still unclear. Purpose This study aimed to analyse the incidence and prognosis of thrombus formation on closure stump line in patients with AF who underwent surgical LAA occlusion. Methods This study retrospectively analised the data from patients treated with two methods of surgical LAA closure, resection or clipping, from January 2014 to November 2018. Results A total of 187 consecutive patients with AF underwent surgical LAA closure (31 clipping and 156 stapler resection). 170 patients (91%) underwent cardiac CT for LAA imaging on postoperative day 2. The incidence of acute procedure-related thrombus formation in full cohort was 19% (35 cases). The incidence of acute thrombus in patients with clipping and resection was 19% and 16%, respectively (Fisher's exact test, p=0.8). All of 35 patients who had thrombus on LAA closure stump line underwent cardiac CT again 3 months after the primary CT. In all patients with secondary cardiac CT, thrombus on LAA closure stump line disappeared. No symptomatic thromboembolism occurred during the follow-up from operation to secondary CT scan. Conclusion(s) Thrombus formation on stump after surgical LAA closure may often occur on acute phase. The optimal LAA imaging and anti-coagulation therapy after surgical LAA occlusion will prevent patients with acute thrombus from thromboembolism.

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