Impact of left atrial appendage morphology on peri-interventional thromboembolic risk during catheter ablation of atrial fibrillation.

Abstract

Left atrial appendage (LAA) morphology recently has been suggested to influence thromboembolic risk in patients with atrial fibrillation (AF). The purpose of this study was to examine the impact of LAA morphology on peri-interventional thromboembolic events in patients undergoing AF catheter ablation. Of 2570 consecutive patients undergoing AF ablation, 17 patients with cerebral thromboembolic events within 30 days of AF ablation were selected and matched for CHA2DS2VASc score, peri-interventional anticoagulation, and procedural characteristics with 68 event-free patients. LAA morphology was visualized by cardiac computed tomography and classified into 4 types: cactus, chicken wing, windsock, and cauliflower. Baseline, echocardiographic, and procedural characteristics of both patient groups were similar. Patients with embolic complications had a significantly higher incidence of chicken wing morphology compared to event-free controls (65% vs. 21% chicken wing, 18% vs. 24% cactus, 12% vs. 13% windsock, 5% vs. 42% cauliflower, respectively, P < .001), which translates into a >7× higher risk compared to other morphologies (odds ratio 7.2, 95% confidence interval 1.353-38.328, P = .021) when adjusted for possible confounders associated with chicken wing morphology. LAA chicken wing morphology is associated with higher periprocedural thromboembolic risk in patients undergoing AF ablation. Further studies are needed to determine the mechanisms and possible implications of this observation.