Key result
LAA closure in AF is associated with ~18% larger orifice areas and lower ejection fractions.
Why the study?
The study aimed to evaluate the morphometrical features of the left atrial appendage in patients with atrial fibrillation undergoing percutaneous closure (LARIAT) for stroke prevention.
Are there differences in the morphometrical features of the left atrial appendage between patients with atrial fibrillation and those with sinus rhythm?
Case-Control (n=101)
Blinded assessors
No
Are there differences in the morphometrical features of the left atrial appendage between patients with atrial fibrillation and those with sinus rhythm?
Absolute Event Rate: 387.2% vs 327.1%
p-value: p=0.02
Patients with atrial fibrillation have significantly larger and more oval LAA orifices and lower LAA ejection fraction compared to patients with sinus rhythm, which may have implications for LAA closure device sizing.
Larger LAA orifices with lower ejection fraction in AF may affect device sizing; leaves open prospective validation of tailored closure strategies.
BACKGROUND: This study aimed to evaluate the morphometrical features of left atrial appendage (LAA) in patients with atrial fibrillation, subjected to LAA percutaneous closure (LARIAT) for stroke prevention. MATERIALS AND METHODS: Computed tomography (CT) scans of 51 patients with atrial fibrillation subjected to LARIAT procedure were comparatively evaluated with 50 patients with sinus rhythm (control group). Three-dimensional reconstructions were created using volume-rendering for evaluation. RESULTS: No differences were found in LAA types of distribution (cauliflower: 25.5 vs. 34.0%, chicken wing: 45.1 vs. 46.0%, arrowhead: 29.4 vs. 20.0%, all p > 0.05) between groups. However, the study group was characterized by LAAs with a lower number of lobes. The LAA orifice anteroposterior and transverse diameters (19.3 ± 4.12 vs. 17.2 ± 4.0 mm, p = 0.01 and 25.1 ± 5.1 vs. 20.5 ± ± 4.4 mm, p = 0.001), orifice area (387.2 ± 133.9 vs. 327.1 ± 128.3 mm2, p = 0.02) and orifice perimeter (70.2 ± 12.5 vs. 61.2 ± 11.6 mm, p = 0.04) was significantly larger in atrial fibrillation patients. More oval LAA orifices was found in atrial fibrillation group (94.0 vs. 70.4%, p = 0.001). No statistically significant differences were found in LAA body length (47.4 ± 15.4 vs. 43.7 ± 10.9 mm, p = 0.17), body width (24.7 ± 5.6 vs. 24.4 ± 5.8 mm, p = 0.81), and chamber depth (17.7 ± 3.5 vs. 16.5 ± 3.8 mm, p = 0.11). Calculated LAA ejection fraction was significantly lower in study group compared to healthy patients (16.4 ± 14.9 vs. 48.2 ± 12.9%, p = 0.001). CONCLUSIONS: Important morphometrical differences in LAA orifice have been found, which was significantly larger and more oval in patients with atrial fibrillation compared to healthy controls. Although no difference in LAA body type and size was observed; the LAA ejection fraction was significantly lower in atrial fibrillation rhythm patients.
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Słodowska et al. (2022) conducted a case-control in Atrial fibrillation (n=101). Atrial fibrillation (LARIAT candidates) vs. Sinus rhythm (healthy controls) was evaluated on Left atrial appendage (LAA) orifice area (mm2) (p=0.02). Patients with atrial fibrillation subjected to LAA closure had a significantly larger LAA orifice area (387.2 vs 327.1 mm2) and lower LAA ejection fraction (16.4% vs 48.2%) compared to controls.
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