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Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation
Published on: February 26, 2013
The left atrial appendage, a small, blind-ended structure: a review of its echocardiographic evaluation and its
Erwan Donal1, Hirotsugu Yamada, Christophe Leclercq
1University Hospital of Rennes, France. erwan.donal@chu-rennes.fr
Insights
Imaging the left atrial appendage (LAA) is crucial for assessing stroke risk in atrial fibrillation patients. Transesophageal echocardiography (TEE) effectively evaluates LAA function and identifies thrombus, guiding therapeutic strategies.
Area of Science:
- Cardiology
- Medical Imaging
- Vascular Biology
Background:
- Rising incidence of stroke and atrial fibrillation necessitates advanced diagnostic tools.
- The left atrial appendage (LAA) is a primary source of cardiac systemic embolic events.
- Understanding LAA anatomy and function is critical for managing thromboembolic risk.
Purpose of the Study:
- To review imaging modalities for evaluating the left atrial appendage (LAA).
- To emphasize the importance of routine LAA analysis in transesophageal echocardiography (TEE).
- To highlight the role of LAA function in atrial fibrillation-related stroke.
Main Methods:
- Utilizing two-dimensional (2-D) and pulsed Doppler transesophageal echocardiography (TEE).
- Assessing LAA emptying flow and identifying spontaneous echo contrast or thrombus.
- Reviewing hemodynamic contributions of the LAA to atrial function.
Main Results:
- TEE is a reproducible method for assessing LAA function and thromboembolic risk.
- 2-D imaging can detect potential thrombus and spontaneous echo contrast within the LAA.
- LAA dysfunction is linked to embolic risks, prompting interventions like ligation or closure devices.
Conclusions:
- Routine TEE analysis, including pulsed Doppler assessment of LAA emptying flow, is essential.
- Accurate imaging and understanding of LAA dysfunction are key to improving stroke prevention strategies.
- Further research is needed to refine the definition, understanding, and treatment of LAA dysfunction.
Abstract:
The increasing prevalence of stroke and atrial fibrillation is a stimulus for new therapeutic strategies and also warrants a review of imaging modalities of the most important source of cardiac systemic embolic events: the left atrial appendage (LAA). This blind-ended, complex structure is embryologically distinct from the body of the left atrium and is sometimes regarded as just a minor extension of the atrium. However, it should routinely be analyzed as part of a transesophageal echocardiographic (TEE) examination. A pulsed Doppler TEE analysis of LAA emptying flow should supplement a two-dimensional (2-D) analysis; these examinations have proven to be highly reproducible and to help assess thromboembolic risk. In 2-D imaging, potential thrombus and spontaneous echo contrast should be sought. In addition, LAA plays a hemodynamic role that participates in atrial function and is influenced by various hemodynamic conditions. In view of the embolic risks from a dysfunctional appendage, the LAA is often ligated during cardiac valve surgery. New devices are under evaluation for percutaneous closure of the LAA, and further studies should improve the definition, understanding, and treatment of LAA dysfunction.
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