Abstract 11182: the Morphological Feature of Left Atrial Appendage with Thrombus in Patients with Atrial Fibrillation

Background: In atrial fibrillation (AF) patients, non-chicken wing type left atrial appendage (LAA) morphology is involved in thromboembolic events, and windsock and cauliflower LAA morphologies have been reported to be related to silent cerebral ischemia (CI). However, the morphology of the LAA in patients with left atrial appendage thrombus (LAAT) that is the main pathogenesis of cardiogenic CI due to AF remains unclear. Methods: We retrospectively studied the LAA morphology in 43 patients with LAAT detected by transesophageal echocardiography (TEE) prior to cardioversion or catheter ablation for AF and the LAA morphology of 144 patients without LAAT who undertook TEE on the same day, out of 1864 examined patients. Patients with significant valvular disease and cardiac surgery were excluded. LAA morphology constructed by computed tomography has been classified into 4 types: chicken wing, cauliflower, windsock, and cactus. We evaluated clinical data, blood samples, and transthoracic echocardiography at the time of TEE. Results: Non-paroxysmal AF (37% vs. 0%, P<0.0001), higher history of heart failure (40% vs. 15%, P=0.0004), elevated BNP level (454±436 vs. 119±133 pg/mL, <0.0001), reduced left ventricular ejection fraction (LVEF, 52.3±16.8% vs. 65.2±10.2%, P <0.0001), larger LA dimension (LAD, 48.6±6.0 vs. 41.9±6.1 mL/m 2 , P<0.0001), higher E/e` ratio (13.4±7.0 vs. 10.7±3.8, p=0.0017), and LAA morphology were associated with LAAT (Figure). On multivariate analysis, non-paroxysmal AF (P=0.0002), BNP level (P=0.0033), LVEF (P=0.0015), and LAA morphology (especially, cactus type LAA, P=0.0027) were significantly correlated to LAAT. Conclusion: The LAA morphology relates to the LAAT in AF patients. The characteristics of the LAA morphology in LAAT patients may be different from those in silent CI patients.