Key result
A superior left atrial appendage takeoff was an independent predictor of thromboembolic events in atrial fibrillation patients with low CHA2DS2-VASc scores (OR 9.1; 95% CI 2.1-38.6; P=0.003).
Why the study?
Is left atrial appendage anatomy associated with thromboembolic events in atrial fibrillation patients with low CHA2DS2-VASc scores?
Case-Control (n=100)
Is left atrial appendage anatomy associated with thromboembolic events in atrial fibrillation patients with low CHA2DS2-VASc scores?
A superior left atrial appendage takeoff is associated with increased thromboembolic risk in atrial fibrillation patients with low CHA2DS2-VASc scores, potentially due to tachycardia-mediated thrombogenic flow.
Answers are grounded in this paper and cite their sources.
Does not yet support incorporating LAA takeoff into anticoagulation decisions; leaves open whether anatomy refines thromboembolic prediction in low CHA2DS2-VASc AF.
Assessing Stroke risK by LAA Anatomy (ASK LAA) Introduction In patients with atrial fibrillation (AF), LAA morphology has been suggested to modify thromboembolic event (TE) risk. We tested the hypothesis that TE in low‐risk patients is associated with LAA characteristics. Methods Of 2,069 patients who underwent AF ablation, 25 (1.2%) had a prior TE and a low CHA 2 DS 2 ‐VASc score (≤1). Those patients were matched for the CHA 2 DS 2 ‐VASc criteria with 75 eventfree patients and CT data were compared. LAA measurements, morphology (Cactus, Chicken‐Wing, Windsock, Cauliflower), and takeoff of the superior and inferior edge in relation (higher or lower) to the respective takeoff of the adjacent pulmonary vein (PV) were determined. LAA flow in relation to heart rate was also compared. Results Univariate analysis showed that TE patients had a higher incidence of superior LAA takeoff (i.e., higher than the left superior PV; 28% vs. 4%, P = 0.002) and a higher incidence of hyperlipidemia (40% vs. 17%, P = 0.028), while LAA morphologies, inferior takeoff, and other LAA characteristics were similar between groups. Logistic regression revealed that a superior LAA takeoff (OR: 9.1, 95% CI: 2.1–38.6, P = 0.003) was the only independent predictor of TE. There was a negative correlation between heart rate and LAA flow (r = –0.2 cm/s pro bpm, P = 0.048), that was even more pronounced for the superior LAA takeoff (r = –0.67 cm/s pro bpm, P = 0.035). Conclusion A higher LAA takeoff is associated with a tachycardia‐mediated thrombogenic flow and an increased thromboembolic risk. These findings may have implications for anticoagulation management of AF patients with low CHA 2 DS 2 ‐VASc scores and higher LAA takeoff.
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Nedios et al. (2015) conducted a case-control in Atrial fibrillation with low CHA2DS2-VASc score (n=100). Superior LAA takeoff vs. Non-superior LAA takeoff was evaluated on Thromboembolic event (TE) (OR 9.1, 95% CI 2.1-38.6, p=0.003). A superior left atrial appendage takeoff was an independent predictor of thromboembolic events in atrial fibrillation patients with low CHA2DS2-VASc scores (OR 9.1; 95% CI 2.1-38.6; P=0.003).
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