Morphologic remodeling of left atrial appendage in patients with atrial fibrillation.

BACKGROUND

Left atrial appendage (LAA) has recently been of significant focus because of the development of the LAA closure device.

OBJECTIVE

The purpose of this study was to test the hypothesis that atrial fibrillation (AF) leads to a morphologic change in the LAA and to investigate the characteristics of LAA morphology in patients with and without AF.

METHODS

This retrospective study included 225 patients (persistent AF [PeAF], n = 76; paroxysmal AF [PAF], n = 70; control, n = 79] who underwent echocardiography and computed tomography (CT). All patients were classified into 2 types (chicken wing [CW] or non-chicken wing [non-CW]) using CT.

RESULTS

The prevalence of non-CW-type LAA was 39.5%, 15.7%, and 8.9% in the PeAF, PAF, and control groups, respectively. Patients in the PeAF group had a higher prevalence of non-CW-type LAA than did those in the PAF and control groups (P = .0014 and P <.0001, respectively). In addition, all patients were divided into 5 groups based on the type of cardiac rhythm (PeAF, PAF, or sinus rhythm) and left atrial volume index (cutoff value; 34 mL/m(2)): group A (Control), group B (PAF/Small-LA), group C (PAF/Large-LA), group D (PeAF/Small-LA), group E (PeAF/Large-LA). The prevalence of non-CW-type LAA was 9%, 14%, 17%, 29%, and 41% in groups A, B, C, D, and E, respectively.

CONCLUSION

Presence of persistent AF was associated with a higher prevalence of non-chicken wing-type LAA. Our analysis suggests that remodeling in patients with persistent AF can lead to a change in LAA morphology.