Impact of left atrial appendage morphology on peri-interventional thromboembolic risk during catheter ablation of atrial fibrillation
Introduction
Atrial fibrillation (AF) is generally acknowledged as 1 of the most important causes of cerebral thromboembolic events.1 Multiple risk factors and different risk assessment models have been proposed,2, 3 but the predictive value of those schemes is still limited when applied to real-world populations4 or so-called low-risk patient groups.5
Because the left atrial appendage (LAA) plays a major role as a thromboembolic source6 in patients with AF, its impact on thromboembolic risk has been addressed. LAA morphology, which recently has been classified into four types (cactus, chicken wing, windsock, and cauliflower), has been suggested to influence thromboembolic risk in AF patients7, 8, 9 and to provide additional value in predicting thromboembolic events in low-risk patient groups.10
The risk of thromboembolic events is also present or even increased during and early after AF catheter ablation.11, 12 Although different pathophysiologic mechanisms and anatomic predispositions may determine the risk of such an event in this specific setting, the role of the LAA and its morphology has not been taken into account.
The aim of this case control study was to examine the impact of LAA morphology on peri-interventional thromboembolic risk in patients undergoing AF catheter ablation.
Section snippets
Patients
Of 2570 patients undergoing AF ablation between 2007 and 2012 at our institution, 17 consecutive patients with cerebral thromboembolic events within 30 days of AF ablation were selected and matched for CHA2DS2VASc score criteria (congestive heart failure, hypertension, age, diabetes mellitus, prior stroke/TIA, and vascular disease) and peri-interventional anticoagulation and procedural characteristics with randomly chosen 68 event-free patients (1:4 ratio). Table 1 lists the baseline
Patient characteristics of different LAA morphologies
In the whole population, the following distribution of 4 morphology types was observed: 19 patients (22%) had cactus morphology, 25 patients (29%) chicken wing, 11 patients (13%) windsock, and 30 patients (35%) cauliflower. Satisfactory level of interobserver agreement was reached (κ 0.70, 95% CI 0.38–0.90, P < .001).
Baseline characteristics and medication and procedural data were not significantly different in patients with different LAA types (Online Supplemental Table 1). However, the
Main findings
To the best of our knowledge, this is the first study illustrating the impact of LAA morphology on peri-interventional thromboembolic risk associated with catheter ablation of AF. In this case control study, we observed chicken wing morphology to be associated with a 7× higher risk of peri-interventional thromboembolic event. This association remained significant after adjustment for possible confounders associated with chicken wing morphology.
Influence of LAA morphology on peri-interventional thromboembolic risk
The impact of different LAA morphologies on
Conclusion
The chicken wing morphology of LAA is associated with higher periprocedural thromboembolic risk in patients undergoing AF ablation. Further studies are needed to illuminate the pathophysiologic mechanisms and clinical implications of this phenomenon.
References (16)
- et al.
Refining clinical risk stratification for predicting stroke and thromboembolism in atrial fibrillation using a novel risk factor-based approach: the euro heart survey on atrial fibrillation
Chest
(2010) - et al.
Comparison of risk stratification schemes to predict thromboembolism in people with nonvalvular atrial fibrillation
J Am Coll Cardiol
(2008) - et al.
Mechanisms of thrombogenesis in atrial fibrillation: Virchow’s triad revisited
Lancet
(2009) - et al.
Does the left atrial appendage morphology correlate with the risk of stroke in patients with atrial fibrillation? Results from a multicenter study
J Am Coll Cardiol
(2012) - et al.
Left Atrial Appendage morphology and silent cerebral ischemia in atrial fibrillation patients
Heart Rhythm
(2014) - et al.
Relationship between left atrial appendage morphology and stroke in patients with atrial fibrillation
Heart Rhythm
(2013) - et al.
Anatomical characteristics of the left atrial appendage in cardiogenic stroke with low CHADS2 scores
Heart Rhythm
(2013) - et al.
Recommendations for chamber quantification: a report from the American Society of Echocardiography’s Guidelines and Standards Committee and the Chamber Quantification Writing Group, developed in conjunction with the European Association of Echocardiography
J Am Soc Echocardiogr
(2005)
Cited by (0)
The first two authors contributed equally to this work.