Anatomical characteristics of the left atrial appendage in thrombosis with low CHA2DS2-VASc scores

Abstract

Objective The aim of this study is to clarify the anatomical characteristics of the left atrial appendage(LAA)in patients with thrombosis and nonvalvular atrial fibrillation(AF)who have low CHA2DS2-VASc scores. Methods From August 2008 to May 2013, 1 982 patients who underwent catheter ablation of AF in Wuhan Asia Heart Hospital received contrast-enhanced computer tomography and transesophageal echocardiography.The LAA characteristics were compared between 27 patients with left atrial appendage thrombus formation and 34 age-matched controls.The LAA anatomy was classified into 4 types— cactus , cauliflower , cockscomb , and windsock — discriminated by the computed tomography measurements of the length, angle, and number of lobes of the LAA. Results There was no significant difference in the baseline data(sex, age, CHA2DS2-VASc score, left ventricular ejection fraction, hypertension, diabetics or type of AF) between patients with thrombosis and controls.However, in patients with cauliflower LAA had significantly more stroke(P=0.044). Logistic regression analysis showed that the cauliflower LAA was an independent predictor of thrombosis. Conclusion The LAA anatomical characteristics may be useful for predicting thrombosis in patients with nonvalvular AF who have low CHA2DS2-VASc scores. Key words: Atrial fibrillation; Left atrial appendage; Thrombosis; CHA2DS2-VASc score