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Left atrial appendage: morphology and function in patients with paroxysmal and persistent atrial fibrillation

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Abstract

The anatomical and functional characteristics of the left atrial appendage (LAA) and its relationships with anatomical remodeling and ischemic stroke in patients with atrial fibrillation (AF) have not been clearly established. The purpose of this study was to determine whether functional and morphological features of the LAA independently predict clinical outcome and stroke in patients with AF who underwent catheter ablation (CA). Two hundred sixty-four patients with AF, including 176 with paroxysmal AF (PAF, 54.0 ± 11.4 years old, M:F = 138:38) and 88 with persistent AF (PeAF, 56.4 ± 9.6 years old, M:F = 74:14) were studied. Of these patients, 31 (11.7 %) had a history of stroke/TIA (transient ischemic attack). The LA and LAA volumes were 124.0 ± 42.4 and 24.9 ± 4.3 ml in PeAF, these values were greater than those in PAF (81.2 ± 24.8 ml and 21.2 ± 5.1 ml, P < 0.001). The AF type (P = 0.016) and AF duration (P = 0.005), and anti-arrhythmic drugs use (P < 0.001) were significant predictors of AF recurrence after CA in all patients. Compared with patients without history of stroke, stroke patients had larger LA volume (106.9 ± 23.0 vs. 94.0 ± 38.9 ml, P = 0.004) and had lower LAA EF (50.0 ± 11.0 vs. 65.7 ± 13.4 %, P < 0.001). The independent predictors of stroke were age (P = 0.002) and LAA EF (P < 0.001) in PAF patients and that was only age (P = 0.001) in PeAF patients. In anatomical and morphological parameters of the LA and LAA, only depressed systolic function of the LAA was significantly related to stroke/TIA and recurrence of AF after CA in paroxysmal AF patients. Further large scaled prospective study is required for validation.

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References

  1. Anderson RH, Razavi R, Taylor AM (2004) Cardiac anatomy revisited. J Anat 205(3):159–177

    Article  PubMed  Google Scholar 

  2. Chang SH, Tsao HM, Wu MH et al (2007) Morphological changes of the left atrial appendage after catheter ablation of atrial fibrillation. J Cardiovasc Electrophysiol 18(1):47–52

    Article  PubMed  Google Scholar 

  3. Corradi D, Callegari S, Benussi S et al (2005) Myocyte changes and their left atrial distribution in patients with chronic atrial fibrillation related to mitral valve disease. Hum Pathol 36(10):1080–1089

    Article  PubMed  Google Scholar 

  4. Daoud EG, Weiss R, Bahu M et al (1996) Effect of an irregular ventricular rhythm on cardiac output. Am J Cardiol 78(12):1433–1436

    Article  PubMed  CAS  Google Scholar 

  5. Shinbane JS, Wood MA, Jensen DN, Ellenbogen KA, Fitzpatrick AP, Scheinman MM (1997) Tachycardia-induced cardiomyopathy: a review of animal models and clinical studies. J Am Coll Cardiol 29(4):709–715

    Article  PubMed  CAS  Google Scholar 

  6. Wolf PA, Abbott RD, Kannel WB (1991) Atrial fibrillation as an independent risk factor for stroke: the Framingham Study. Stroke 22(8):983–988

    Article  PubMed  CAS  Google Scholar 

  7. Fuster V, Ryden LE, Cannom DS et al (2006) ACC/AHA/ESC 2006 guidelines for the management of patients with atrial fibrillation: a report of the American College of Cardiology/American Heart Association Task Force on practice guidelines and the European Society of Cardiology Committee for practice guidelines (Writing Committee to revise the 2001 guidelines for the management of patients with atrial fibrillation): developed in collaboration with the European Heart Rhythm Association and the Heart Rhythm Society. Circulation 114(7):e257–e354

    Article  PubMed  Google Scholar 

  8. Lo LW, Tai CT, Lin YJ et al (2009) Predicting factors for atrial fibrillation acute termination during catheter ablation procedures: implications for catheter ablation strategy and long-term outcome. Heart Rhythm 6(3):311–318

    Article  PubMed  Google Scholar 

  9. Berruezo A, Tamborero D, Mont L et al (2007) Pre-procedural predictors of atrial fibrillation recurrence after circumferential pulmonary vein ablation. Eur Heart J 28(7):836–841

    Article  PubMed  Google Scholar 

  10. Qamruddin S, Shinbane J, Shriki J, Naqvi TZ (2010) Left atrial appendage: structure, function, imaging modalities and therapeutic options. Expert Rev Cardiovasc Ther 8(1):65–75

    Article  PubMed  Google Scholar 

  11. Calkins H, Brugada J, Packer DL et al (2007) HRS/EHRA/ECAS expert consensus statement on catheter and surgical ablation of atrial fibrillation: recommendations for personnel, policy, procedures and follow-up. A report of the Heart Rhythm Society (HRS) Task Force on catheter and surgical ablation of atrial fibrillation. Heart Rhythm 4(6):816–861

    Article  PubMed  Google Scholar 

  12. Natale A, Raviele A, Arentz T et al (2007) Venice Chart international consensus document on atrial fibrillation ablation. J Cardiovasc Electrophysiol 18(5):560–580

    Article  PubMed  Google Scholar 

  13. Pollak A, Falk RH (1995) Aggravation of postcardioversion atrial dysfunction by sotalol. J Am Coll Cardiol 25(3):665–671

    Article  PubMed  CAS  Google Scholar 

  14. Wang Y, Di Biase L, Horton RP, Nguyen T, Morhanty P, Natale A (2010) Left atrial appendage studied by computed tomography to help planning for appendage closure device placement. J Cardiovasc Electrophysiol 21(9):973–982

    Article  PubMed  Google Scholar 

  15. Beinart R, Heist EK, Newell JB, Holmvang G, Ruskin JN, Mansour M (2011) Left atrial appendage dimensions predict the risk of stroke/TIA in patients with atrial fibrillation. J Cardiovasc Electrophysiol 22(1):10–15

    Article  PubMed  Google Scholar 

  16. Pollick C, Taylor D (1991) Assessment of left atrial appendage function by transesophageal echocardiography. Implications for the development of thrombus. Circulation 84(1):223–231

    Article  PubMed  CAS  Google Scholar 

  17. Sahin T, Ural D, Kilic T et al (2009) Evaluation of left atrial appendage functions according to different etiologies of atrial fibrillation with a tissue Doppler imaging technique by using transesophageal echocardiography. Echocardiography 26(2):171–181

    Article  PubMed  Google Scholar 

  18. Fleming HA, Bailey SM (1971) Mitral valve disease, systemic embolism and anticoagulants. Postgrad Med J 47(551):599–604

    Article  PubMed  CAS  Google Scholar 

  19. Neilson GH, Galea EG, Hossack KF (1978) Thromboembolic complications of mitral valve disease. Aust N Z J Med 8(4):372–376

    Article  PubMed  CAS  Google Scholar 

  20. Al-Saady NM, Obel OA, Camm AJ (1999) Left atrial appendage: structure, function, and role in thromboembolism. Heart 82(5):547–554

    PubMed  CAS  Google Scholar 

  21. Kamp O, Verhorst PM, Welling RC, Visser CA (1999) Importance of left atrial appendage flow as a predictor of thromboembolic events in patients with atrial fibrillation. Eur Heart J 20(13):979–985

    Article  PubMed  CAS  Google Scholar 

  22. Choudhury A, Lip GY (2003) Atrial fibrillation and the hypercoagulable state: from basic science to clinical practice. Pathophysiol Haemost Thromb 33(5–6):282–289

    Article  PubMed  Google Scholar 

  23. Heppell RM, Berkin KE, McLenachan JM, Davies JA (1997) Haemostatic and haemodynamic abnormalities associated with left atrial thrombosis in non-rheumatic atrial fibrillation. Heart 77(5):407–411

    PubMed  CAS  Google Scholar 

  24. Leithauser B, Park JW (2009) Cardioembolic stroke in atrial fibrillation-rationale for preventive closure of the left atrial appendage. Korean Circ J 39(11):443–458

    Article  PubMed  Google Scholar 

  25. Ernst G, Stollberger C, Abzieher F et al (1995) Morphology of the left atrial appendage. Anat Rec 242(4):553–561

    Article  PubMed  CAS  Google Scholar 

  26. Shirani J, Alaeddini J (2000) Structural remodeling of the left atrial appendage in patients with chronic non-valvular atrial fibrillation: implications for thrombus formation, systemic embolism, and assessment by transesophageal echocardiography. Cardiovasc Pathol 9(2):95–101

    Article  PubMed  CAS  Google Scholar 

  27. Parikh SS, Jons C, McNitt S, Daubert JP, Schwarz KQ, Hall B (2010) Predictive capability of left atrial size measured by CT, TEE, and TTE for recurrence of atrial fibrillation following radiofrequency catheter ablation. Pacing Clin Electrophysiol 33(5):532–540

    Article  PubMed  Google Scholar 

  28. von Bary C, Dornia C, Eissnert C et al (2012) Predictive value of left atrial volume measured by non-invasive cardiac imaging in the treatment of paroxysmal atrial fibrillation. J Interv Card Electrophysiol 34(2):181–188

    Article  Google Scholar 

  29. (2007) Independent predictors of stroke in patients with atrial fibrillation: a systematic review. Neurology 69(6):546–554

  30. (1996) Silent brain infarction in nonrheumatic atrial fibrillation. EAFT Study Group. European atrial fibrillation trial. Neurology 46(1):159–165

  31. Das RR, Seshadri S, Beiser AS et al (2008) Prevalence and correlates of silent cerebral infarcts in the Framingham offspring study. Stroke 39(11):2929–2935

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Internal Medicine, College of Medicine, Hanyang University Guri Hospital, Guri city, Republic of Korea

    Hwan-Cheol Park & Jinho Shin

  2. Arrhythmia Center, College of Medicine, Korea University Medical Center, 126-1, 5 ga, Anam-dong, Seongbuk-gu, Seoul, 136-705, Republic of Korea

    Ji-Eun Ban, Jong-Il Choi, Sang-Weon Park & Young-Hoon Kim

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  1. Hwan-Cheol Park
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  2. Jinho Shin
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Correspondence to Young-Hoon Kim.

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Park, HC., Shin, J., Ban, JE. et al. Left atrial appendage: morphology and function in patients with paroxysmal and persistent atrial fibrillation. Int J Cardiovasc Imaging 29, 935–944 (2013). https://doi.org/10.1007/s10554-012-0161-y

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  • DOI: https://doi.org/10.1007/s10554-012-0161-y

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