Three-dimensional echocardiography imaging of the right atrial appendage and events in patient with atrial fibrillation

Introduction Few studies have described the morphology and function of the right atrial appendage (RAA). Purpose We assessed whether 3D transesophageal echocardiography (TEE) characterizes RAA anatomy and function and could be linked to prognosis in atrial fibrillation (AF). Methods We prospectively evaluated 202 patients hospitalized for AF using 2D transthoracic echocardiography (TTE) and 2D/3D TEE. 3D parameters were analyzed offline. 2D RAA spontaneous echo contrast, 2D end-systolic (ES) and end-diastolic (ED) RAA ostium diameters, 2D ES/ED RAA depth, 2D ES/ED RAA areas, 3D ES/ED RAA volumes, 3D RAA emptying fraction, and 3D RAA morphology were assessed. Patients were categorized according to AF recurrence and MACE at 2 years of follow up. Results The median (interquartile range [IQR]) age of the 202 patients was 67.1 (59.9-74.1) years, 126 (62.4%) were male, and 153 (75.7%) had a CHA2DS2-VASc score ≥2; 142 (70.3%) had persistent AF. Median (IQR) 2D ES RAA area was 4.7 (3.4-6.3) cm2 and 3D ES RAA volume was 15.4 (11.1-21.9) mL. Most patients (88.7%) exhibited a "bowl" morphology; all had 1 RAA lobe. The echocardiographic characteristics are displayed in Figure A. On Kaplan Meier analysis, patients with highest RAAV have higher risk of AF recurrence, MACE, and AF recurrence/MACE (respectively p=0,0334; p =0.0304 ; p=0.0161) Figure B. Conclusions A novel 3D TEE approach can accurately delineate geometry, size, and function of the RAA in AF. Remodeling of the RAA in AF may be beneficial for characterizing the AF substrate and its consequences (atrial cardiomyopathy) and to evaluate the risk of AF recurrence and MACE.