Abstract 10879: Does the Left Atrial Appendage Morphology Correlates with the Risk of Stroke in Patients with Atrial Fibrillation? Result from a Multicenter Study
Introduction: The left atrial appendage (LAA) represents one of the major sources of cardiac thrombus formation responsible for TIA/stroke in patients with atrial fibrillation (AF). We quantitatively studied various morphologic parameters of the left atrial appendage (LAA) by computed tomography (CT) and by magnetic resonance imaging (MRI) to categorize different LAA morphologies and tried to correlate the morphology with the history of stroke/TIA.
Methods: The study population consisted of 932 patients with drug refractory atrial fibrillation (AF) planning to undergo AF ablation. All patients underwent cardiac CT or MRI and care was taken to obtain LAA frames. All patients were screened for history of TIA/stroke. LAAs were categorized into different morphologies which included Chicken Wing, Windsock, Cauliflower and Cactus.
Results: CT images of 499 patients and MRI images of 433 patients were analyzed (59±10 yrs, 79% male, BMI 27±4, EF 60±7, 14% CHADS2 ≥2). The LAA was categorized into four morphologies: 278(30%) patients were classified as Cactus, 451(48%) as Chicken Wing, 179(19%) as Windsock and 24(3%) as Cauliflower. Out of the 932 patients, 73(8%) patients had prior history of ischemic stroke or transient ischemic attack. The prevalence of pre-procedure stroke/TIA in Cactus, Chicken Wing, Windsock, and Cauliflower morphologies were 12%, 4%, 10%, and 18% respectively (p 0.003). After controlling for CHADS2 score, gender, and AF types in a multivariable logistic model, Chicken Wing morphology was found to be more likely to remain stroke-free (odds ratio 19, p= 0.043). In separate multivariate model we entered chicken wing as reference group and assessed the likelihood of stroke in other groups in relation to reference. Compared to chicken wing, Cactus had 4.08 times (p= 0.046), Windsock- 4.5 times (p=0.038), and Cauliflower 8.0 times (p=0.056) more likely to have an ischemic event.
Conclusion: This study suggests that patients with chicken wing morphology are less likely to have an embolic event even after controlling for comorbidities. If confirmed, these results could have a relevant impact on the anticoagulation management of patients with an intermediate risk for stroke.
- © 2011 by American Heart Association, Inc.