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  • Title: Left atrial appendage morphology and thromboembolic risk after catheter ablation for atrial fibrillation.
    Author: Nedios S, Kornej J, Koutalas E, Bertagnolli L, Kosiuk J, Rolf S, Arya A, Sommer P, Husser D, Hindricks G, Bollmann A.
    Journal: Heart Rhythm; 2014 Dec; 11(12):2239-46. PubMed ID: 25128733.
    Abstract:
    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.
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