BACKGROUND: In patients with atrial fibrillation (AF), left atrial appendage (LAA) morphology has been suggested to modify risk of thromboembolic events (TEs). OBJECTIVE: In this study, we tested the hypothesis that a TE after AF catheter ablation is associated with LAA characteristics. METHODS: Of 2069 patients included in the Leipzig Heart Center AF Ablation Registry, 15 (0.7%) suffered a TE (excluding events within 30 days) during follow-up (ie, 3.078 patient-years). Those patients were matched for CHA2DS2-VASc criteria with 115 patients without TE, and computed tomography (n = 120) or magnetic resonance imaging (n = 10) data were also compared. LAA volume, morphology (cactus, chicken-wing, windsock, and cauliflower), and takeoff (higher/lower) in relation to the adjacent pulmonary vein were determined. RESULTS: After patients were followed for a median period of 24 months, 67% of the patients remained in sinus rhythm. Patients with TE had a higher AF recurrence rate (73% vs 28%; P = .001) and a higher incidence of superior LAA takeoff (ie, higher than that of the left superior pulmonary vein; 80% vs 37%; P = .002), while LAA morphologies and other LAA characteristics were similar between groups. Multivariate Cox regression analysis revealed AF recurrence (hazard ratio 6.2; 95% confidence interval 2.0-19.6; P = .002) and superior LAA takeoff (hazard ratio 4.9; 95% confidence interval 1.4-17.4; P = .014) as TE predictors. There was a negative correlation between heart rate and LAA flow (r = -.22 cm/s per beat/min; P = .016), which was even more pronounced for the superior LAA takeoff (r = -.28 cm/s; P = .045). CONCLUSION: AF recurrence and higher LAA takeoff are associated with thromboembolism after AF ablation, while LAA morphology is not. These results may have an implication for improved postablation management.
BACKGROUND: In patients with atrial fibrillation (AF), left atrial appendage (LAA) morphology has been suggested to modify risk of thromboembolic events (TEs). OBJECTIVE: In this study, we tested the hypothesis that a TE after AF catheter ablation is associated with LAA characteristics. METHODS: Of 2069 patients included in the Leipzig Heart Center AF Ablation Registry, 15 (0.7%) suffered a TE (excluding events within 30 days) during follow-up (ie, 3.078 patient-years). Those patients were matched for CHA2DS2-VASc criteria with 115 patients without TE, and computed tomography (n = 120) or magnetic resonance imaging (n = 10) data were also compared. LAA volume, morphology (cactus, chicken-wing, windsock, and cauliflower), and takeoff (higher/lower) in relation to the adjacent pulmonary vein were determined. RESULTS: After patients were followed for a median period of 24 months, 67% of the patients remained in sinus rhythm. Patients with TE had a higher AF recurrence rate (73% vs 28%; P = .001) and a higher incidence of superior LAA takeoff (ie, higher than that of the left superior pulmonary vein; 80% vs 37%; P = .002), while LAA morphologies and other LAA characteristics were similar between groups. Multivariate Cox regression analysis revealed AF recurrence (hazard ratio 6.2; 95% confidence interval 2.0-19.6; P = .002) and superior LAA takeoff (hazard ratio 4.9; 95% confidence interval 1.4-17.4; P = .014) as TE predictors. There was a negative correlation between heart rate and LAA flow (r = -.22 cm/s per beat/min; P = .016), which was even more pronounced for the superior LAA takeoff (r = -.28 cm/s; P = .045). CONCLUSION:AF recurrence and higher LAA takeoff are associated with thromboembolism after AF ablation, while LAA morphology is not. These results may have an implication for improved postablation management.
Authors: Faith R Kelly; Robert A Hull; Takor B Arrey-Mbi; Michael U Williams; Joshua S Lee; Ahmad M Slim; Dustin M Thomas Journal: BMC Cardiovasc Disord Date: 2017-02-28 Impact factor: 2.298
Authors: Joshua Cates; Erik Bieging; Alan Morris; Gregory Gardner; Nazem Akoum; Eugene Kholmovski; Nassir Marrouche; Christopher McGann; Rob S MacLeod Journal: Clin Med Insights Cardiol Date: 2015-08-26
Authors: Miika Korhonen; Johannes Parkkonen; Marja Hedman; Antti Muuronen; Juha Onatsu; Pirjo Mustonen; Ritva Vanninen; Mikko Taina Journal: PLoS One Date: 2017-03-13 Impact factor: 3.240
Authors: Soroosh Sanatkhani; Sotirios Nedios; Prahlad G Menon; Andreas Bollmann; Gerhard Hindricks; Sanjeev G Shroff Journal: Front Physiol Date: 2021-05-11 Impact factor: 4.566