title: Left atrial appendage morphology and thromboembolic risk after catheter ablation for atrial fibrillation.
abstract: BACKGROUND
  In patients with atrial fibrillation (AF), left atrial appendage (LAA) morphology has been suggested to modify risk of thromboembolic events (TEs).
  
  
  OBJECTIVE
  In this study, we tested the hypothesis that a TE after AF catheter ablation is associated with LAA characteristics.
  
  
  METHODS
  Of 2069 patients included in the Leipzig Heart Center AF Ablation Registry, 15 (0.7%) suffered a TE (excluding events within 30 days) during follow-up (ie, 3.078 patient-years). Those patients were matched for CHA2DS2-VASc criteria with 115 patients without TE, and computed tomography (n = 120) or magnetic resonance imaging (n = 10) data were also compared. LAA volume, morphology (cactus, chicken-wing, windsock, and cauliflower), and takeoff (higher/lower) in relation to the adjacent pulmonary vein were determined.
  
  
  RESULTS
  After patients were followed for a median period of 24 months, 67% of the patients remained in sinus rhythm. Patients with TE had a higher AF recurrence rate (73% vs 28%; P = .001) and a higher incidence of superior LAA takeoff (ie, higher than that of the left superior pulmonary vein; 80% vs 37%; P = .002), while LAA morphologies and other LAA characteristics were similar between groups. Multivariate Cox regression analysis revealed AF recurrence (hazard ratio 6.2; 95% confidence interval 2.0-19.6; P = .002) and superior LAA takeoff (hazard ratio 4.9; 95% confidence interval 1.4-17.4; P = .014) as TE predictors. There was a negative correlation between heart rate and LAA flow (r = -.22 cm/s per beat/min; P = .016), which was even more pronounced for the superior LAA takeoff (r = -.28 cm/s; P = .045).
  
  
  CONCLUSIONS
  AF recurrence and higher LAA takeoff are associated with thromboembolism after AF ablation, while LAA morphology is not. These results may have an implication for improved postablation management.
authors.affiliation: Department of Electrophysiology, Heart Center, University of Leipzig, Leipzig, Germany. Electronic address: snedios@gmail.com.
authors.forename: Sotirios
authors.initials: S
authors.lastname: Nedios
authors.affiliation: Department of Electrophysiology, Heart Center, University of Leipzig, Leipzig, Germany.
authors.forename: Jelena
authors.initials: J
authors.lastname: Kornej
authors.affiliation: Department of Electrophysiology, Heart Center, University of Leipzig, Leipzig, Germany.
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Koutalas
authors.affiliation: Department of Electrophysiology, Heart Center, University of Leipzig, Leipzig, Germany.
authors.forename: Livio
authors.initials: L
authors.lastname: Bertagnolli
authors.affiliation: Department of Electrophysiology, Heart Center, University of Leipzig, Leipzig, Germany.
authors.forename: Jedrzej
authors.initials: J
authors.lastname: Kosiuk
authors.affiliation: Department of Electrophysiology, Heart Center, University of Leipzig, Leipzig, Germany.
authors.forename: Sascha
authors.initials: S
authors.lastname: Rolf
authors.affiliation: Department of Electrophysiology, Heart Center, University of Leipzig, Leipzig, Germany.
authors.forename: Arash
authors.initials: A
authors.lastname: Arya
authors.affiliation: Department of Electrophysiology, Heart Center, University of Leipzig, Leipzig, Germany.
authors.forename: Philipp
authors.initials: P
authors.lastname: Sommer
authors.affiliation: Department of Electrophysiology, Heart Center, University of Leipzig, Leipzig, Germany.
authors.forename: Daniela
authors.initials: D
authors.lastname: Husser
authors.affiliation: Department of Electrophysiology, Heart Center, University of Leipzig, Leipzig, Germany.
authors.forename: Gerhard
authors.initials: G
authors.lastname: Hindricks
authors.affiliation: Department of Electrophysiology, Heart Center, University of Leipzig, Leipzig, Germany.
authors.forename: Andreas
authors.initials: A
authors.lastname: Bollmann
mesh_terms: D000368:Aged; D000704:Analysis of Variance; D020517:Atrial Appendage / Q000000981:diagnostic imaging* / Q000601:surgery; D001281:Atrial Fibrillation / Q000175:diagnosis / Q000601:surgery*; D016022:Case-Control Studies; D017115:Catheter Ablation / Q000009:adverse effects* / Q000379:methods; D004562:Electrocardiography / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D021621:Imaging, Three-Dimensional; D002546:Ischemic Attack, Transient / Q000209:etiology / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D061330:Multidetector Computed Tomography / Q000379:methods; D011183:Postoperative Complications / Q000175:diagnosis / Q000453:epidemiology; D011237:Predictive Value of Tests; D012008:Recurrence; D012016:Reference Values; D012042:Registries; D012720:Severity of Illness Index; D020521:Stroke / Q000209:etiology / Q000503:physiopathology; D013923:Thromboembolism / Q000209:etiology* / Q000503:physiopathology; D016896:Treatment Outcome
keywords: Atrial fibrillation; CHA(2)DS(2)-VASc; Catheter ablation; Left atrial appendage; Stroke/transient ischemic attack prevention