Page 15 - Journal of Structural Heart Disease Volume 3, Issue 1

Original Scienti c Article
Journal of Structural Heart Disease, February 2017, Volume 3, Issue 1:8-14
DOI: http://dx.doi.org/10.12945/j.jshd.2017.16.003
Received: April 5, 2016 Accepted: July 5, 2016 Published online: February 2017
Left Atrial Appendage Morphology in Patients with Non-Valvular Atrial Fibrillation
Sonya Joy, MD1*, Horst Sievert, MD1,2, Stefan Bertog, MD1,3, Timothy Betts, MD4, Neil Wilson, MD1,5, Saul Myerson, MD6
1 CardioVascular Center, Frankfurt, Germany
2 Anglia Ruskin University , Cambridge and Chelmsford, UK
3 Interventional Cardiology Veterans Administration Medical Center, University of Minnesota, Minneapolis, USA 4 Oxford University Hospitals NHS Trust, Oxford, UK
5 Childrens Hospital Colorado, Colorado, USA
6 University of Oxford Centre for Clinical Magnetic Resonance Research, Oxford, UK
Abstract
thrombus detection with TOE emphasizing the impor- tance of multiple views to ensure complete assessment. Copyright © 2017 Science International Corp.
Key Words
Left atrial appendage • Left atrial appendage morphology • Left atrial appendage closure • Atrial brillation
Introduction
Stroke is the most devastating atrial brillation (AF)-related event. Non-valvular chronic AF is associ- ated with a more than 5-fold increase in stroke risk [1], with the left atrial appendage (LAA) as the site of thrombogenesis in more than 90% of stroke victims [2]. Although oral anticoagulation with warfarin re- duces this risk by more than half [3, 4], only 50–70% of patients with AF who are eligible for anticoagulation actually receive it. Novel anticoagulants are at least as e ective as warfarin, but a signi cant bleeding risk re- mains. Thus, alternative options for stroke prevention are needed, particularly for patients with contraindi- cations to anticoagulation.
Percutaneous LAA closure has the advantage of obviating long-term anticoagulation. The PRO- TECT-AF trial demonstrated that percutaneous LAA
* Corresponding Author:
Horst Sievert, MD
Cardiovascular Center
Seckbacher Landstrasse 65, 60389 Frankfurt, Germany
Tel. +49 69 4603-1343, Fax: +49 69 4603-1343, E-Mail: horstsievertmd@aol.com
Aims: Percutaneous left atrial appendage (LAA) occlu- sion has now become a suitable alternative to oral anti- coagulation for stroke prevention in selected patients with atrial brillation (AF). However, LAA closure can be technically challenging and results suboptimal, in part due to variable left atrial anatomy.We aimed to characterize LAA morphology and identify potential anatomical pitfalls during LAA closure or LAA throm- bus detection during transoesophageal echocardiog- raphy (TOE).
Methods and Results: 103 patients with AF underwent cardiac magnetic resonance angiography to assess pulmonary venous anatomy. Adequate imaging qual- ity was present in 76 in whom LAA morphology was assessed. The majority of LAAs (71%) were anterolat- erally directed and 82% were ‘claw’-shaped. However, there was signi cant variation in anatomy and course in the remainder: 11% were anteverted, 9% laterally directed and 9% retroverted. The shape was cone-like in 8%, fan-like in 5% and s-con gured in 5% and there was signi cant variation in the curvature of the LAA body. While 66% had a single lobe, 30% were bilobed and 4% trilobed; 90% also had additional lobules. Conclusion: Our results demonstrate the signi cant vari- ability of LAA geometry in AF patients. This may have implications for future device design for percutaneous LAA occlusion. The variable anatomy may a ect LAA
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