Abstract 20591: A Simple Novel Classification of Left Atrial Appendage Morphology Predicts Stroke in Patients With Atrial Fibrillation
Introduction: Prior Left atrial appendage (LAA) morphology classification (cauliflower, windsock, cactus and chicken wing) have been made based on resemblance to “poorly defined” structures and may be difficult to replicate.
Hypothesis: A more structured, easily replicable classification of LAA morphology would predict the risk of stroke in patients with atrial fibrillation (AF).
Methods: Consecutive patients who underwent CT scan of the heart prior to AF ablation were included in this study. LAA morphology was classified into Class 1, Class 2 and Class 3 based on number of primary curvatures/bends on LAA (0, 1 and ≥2 bends respectively) by 2 independent observers. Patient variables including CHADS2 score, history of stroke, TEE determined LAA variables were collected and analyzed.
Results: A total of 265 patients in whom CT was available with TEE findings were included in the current study. Mean age of the population was 60 ±9 years. Mean CHADS2 score was 1.18 ±0.9 and mean LA size was 4.3 ±0.6cm with a mean LVEF of 60 ±8. Twenty five (9.5%) patients had a history of stroke. Class 1, 2 and 3 groups comprised of 48 (18%), 95 (36%) and 122 (46%) patients respectively. The prevalence of stroke among these groups were 5.6%, 5.6% and 14% respectively. Class 3 LAA morphology (≥2 LAA bends) was much more likely to be associated with stroke when compared to the other 2 morphologies (14% vs 5.6%; p =0.021). This association was significant despite adjusting for baseline and TEE variables of LAA function. We also classified LAAs based on older classification. There was lesser inter-observer variability (6% vs 16%; p<0.001) with our newer classification when compared to the older classification.
Conclusions: A novel classification of the LAA morphology is more reliable than the older classification. Patients with Class 3 LAA morphology (≥2 bends) are much more likely to have had a stroke compared to those with Class 1 or 2 morphology.
Author Disclosures: M. Reddy: None. P. Janga: None. B. Barnds: None. A. Kanmanthareddy: None. J. Pillarisetti: None. S. Bommana: None. D. Atkins: None. D. Lakkireddy: None.
- © 2014 by American Heart Association, Inc.