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  • Title: Impact of left atrial appendage morphology on peri-interventional thromboembolic risk during catheter ablation of atrial fibrillation.
    Author: Kosiuk J, Nedios S, Kornej J, Koutalas E, Bertagnolli L, Rolf S, Arya A, Sommer P, Husser D, Hindricks G, Bollmann A.
    Journal: Heart Rhythm; 2014 Sep; 11(9):1522-7. PubMed ID: 24858813.
    Abstract:
    BACKGROUND: Left atrial appendage (LAA) morphology recently has been suggested to influence thromboembolic risk in patients with atrial fibrillation (AF). OBJECTIVE: The purpose of this study was to examine the impact of LAA morphology on peri-interventional thromboembolic events in patients undergoing AF catheter ablation. METHODS: Of 2570 consecutive patients undergoing AF ablation, 17 patients with cerebral thromboembolic events within 30 days of AF ablation were selected and matched for CHA2DS2VASc score, peri-interventional anticoagulation, and procedural characteristics with 68 event-free patients. LAA morphology was visualized by cardiac computed tomography and classified into 4 types: cactus, chicken wing, windsock, and cauliflower. RESULTS: Baseline, echocardiographic, and procedural characteristics of both patient groups were similar. Patients with embolic complications had a significantly higher incidence of chicken wing morphology compared to event-free controls (65% vs. 21% chicken wing, 18% vs. 24% cactus, 12% vs. 13% windsock, 5% vs. 42% cauliflower, respectively, P < .001), which translates into a >7× higher risk compared to other morphologies (odds ratio 7.2, 95% confidence interval 1.353-38.328, P = .021) when adjusted for possible confounders associated with chicken wing morphology. CONCLUSION: LAA chicken wing morphology is associated with higher periprocedural thromboembolic risk in patients undergoing AF ablation. Further studies are needed to determine the mechanisms and possible implications of this observation.
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