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Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation
Published on: February 26, 2013
Relationship of left atrial appendage function to left ventricular function
Asha Mahilmaran1, Pradeep G Nayar, G Sudarsana
1Institutefor Cardiac Treatment and Research, Southern Railway Hospital, Chennai. ashamahil@hotmail.com
Insights
Left ventricular dysfunction impairs left atrial appendage function, leading to reduced blood flow velocities and a higher risk of thrombus formation, even in patients with normal heart rhythm.
Area of Science:
- Cardiology
- Echocardiography
- Thrombosis
Background:
- Left ventricular dysfunction is a common cardiovascular condition.
- The left atrial appendage is a potential site for thrombus formation.
- Sinus rhythm does not always prevent thrombus formation in the left atrial appendage.
Purpose of the Study:
- To evaluate the relationship between left atrial appendage function and left ventricular function.
- To determine if left ventricular dysfunction increases the risk of left atrial appendage thrombus formation in patients with sinus rhythm.
Main Methods:
- Transesophageal echocardiography was used to assess left atrial appendage function.
- Patients were categorized into groups based on left ventricular ejection fraction.
- Presence of spontaneous echo contrast and thrombus was evaluated.
Main Results:
- Patients with severe and moderate left ventricular dysfunction showed significantly lower left atrial appendage emptying and filling velocities compared to those with preserved function.
- Left atrial appendage thrombus was found in 38% of patients with severe left ventricular dysfunction and 28% with moderate dysfunction.
- No thrombus was observed in patients with preserved left ventricular ejection fraction.
Conclusions:
- Left ventricular dysfunction is associated with impaired left atrial appendage function, characterized by reduced blood flow velocities.
- Left ventricular dysfunction significantly increases the incidence of left atrial appendage thrombus formation, irrespective of heart rhythm.
Background:
The study was conducted to evaluate the relationship of left atrial appendage function to left ventricular function and to analyze, if left ventricular dysfunction predisposed to left atrial appendage thrombus formation even in the presence of sinus rhythm.
Methods And Results:
The study was conducted in 78 patients with a mean age of 53+/-8.5 years, all of whom were in sinus rhythm. Transesophageal echocardiography was performed to record the left atrial appendage emptying and filling velocity and to look for the presence of spontaneous echo contrast and thrombus. Patients with severe left ventricular dysfunction (Group I--left ventricular ejection fraction < 35%) and patients with moderate left ventricular dysfunction (Group II--left ventricular ejection fraction 35-45%) had lower left atrial appendage emptying velocity (33.6+/-16 and 39.7+/-19.5 cm/s, respectively) and filling velocity (41+/-14.7 and 41+/-17 cm/s, respectively) when compared to patients with preserved systolic function (Group II--left ventricular ejection fraction >45%), who had emptying and filling velocity of 55+/-16 and 56+/-15 cm/s, respectively (p <0.05). Twelve out of 32 (38%) patients with severe left ventricular dysfunction (Group I) and 7 out of 25 (28%) patients with moderate left ventricular dysfunction (Group II) had presence of left atrial appendage thrombus as compared to none of the patients with preserved left ventricular ejection fraction (Group III) (p <0.001).
Conclusions:
Patients with left ventricular dysfunction also had left atrial appendage dysfunction as evidenced by lower emptying and filling velocities and had increased incidence of thrombus formation.
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