title: Impact of left atrial appendage morphology on peri-interventional thromboembolic risk during catheter ablation of atrial fibrillation.
abstract: BACKGROUND
  Left atrial appendage (LAA) morphology recently has been suggested to influence thromboembolic risk in patients with atrial fibrillation (AF).
  
  
  OBJECTIVE
  The purpose of this study was to examine the impact of LAA morphology on peri-interventional thromboembolic events in patients undergoing AF catheter ablation.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Electrophysiology, Heart Center Leipzig, Leipzig, Germany. Electronic address: jedrzejkosiuk@hotmail.com.
authors.forename: Jedrzej
authors.initials: J
authors.lastname: Kosiuk
authors.affiliation: Department of Electrophysiology, Heart Center Leipzig, Leipzig, Germany.
authors.forename: Sotirios
authors.initials: S
authors.lastname: Nedios
authors.affiliation: Department of Electrophysiology, Heart Center Leipzig, Leipzig, Germany.
authors.forename: Jelena
authors.initials: J
authors.lastname: Kornej
authors.affiliation: Department of Electrophysiology, Heart Center Leipzig, Leipzig, Germany.
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Koutalas
authors.affiliation: Division of Cardiology, Bolzano Regional Hospital, Bolzano, Italy.
authors.forename: Livio
authors.initials: L
authors.lastname: Bertagnolli
authors.affiliation: Department of Electrophysiology, Heart Center Leipzig, Leipzig, Germany.
authors.forename: Sascha
authors.initials: S
authors.lastname: Rolf
authors.affiliation: Department of Electrophysiology, Heart Center Leipzig, Leipzig, Germany.
authors.forename: Arash
authors.initials: A
authors.lastname: Arya
authors.affiliation: Department of Electrophysiology, Heart Center Leipzig, Leipzig, Germany.
authors.forename: Philipp
authors.initials: P
authors.lastname: Sommer
authors.affiliation: Department of Electrophysiology, Heart Center Leipzig, Leipzig, Germany.
authors.forename: Daniela
authors.initials: D
authors.lastname: Husser
authors.affiliation: Department of Electrophysiology, Heart Center Leipzig, Leipzig, Germany.
authors.forename: Gerhard
authors.initials: G
authors.lastname: Hindricks
authors.affiliation: Department of Electrophysiology, Heart Center Leipzig, Leipzig, Germany.
authors.forename: Andreas
authors.initials: A
authors.lastname: Bollmann
mesh_terms: D020517:Atrial Appendage / Q000002:abnormalities* / Q000000981:diagnostic imaging; D001281:Atrial Fibrillation / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D017115:Catheter Ablation; D017548:Echocardiography, Transesophageal; D005260:Female; D005500:Follow-Up Studies; D005858:Germany / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D020767:Intracranial Thrombosis / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology*; D007431:Intraoperative Complications; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D012189:Retrospective Studies; D012307:Risk Factors; D014057:Tomography, X-Ray Computed
keywords: Atrial fibrillation ablation; Complications; Left atrial appendage; Stroke; Thromboembolism