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Updated: May 14, 2026
Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation
Published on: February 26, 2013
Anatomical characteristics of the left atrial appendage in cardiogenic stroke with low CHADS2 scores
Takehiro Kimura1, Seiji Takatsuki, Kohei Inagawa
1Department of Cardiology, Keio University School of Medicine, Tokyo, Japan. kimura@z7.keio.jp
Insights
Left atrial appendage (LAA) morphology, specifically a "cauliflower" shape, is a significant predictor of stroke in nonvalvular atrial fibrillation (AF) patients with low CHADS₂ scores. This anatomical feature offers a new risk stratification tool beyond traditional scoring systems.
Area of Science:
- Cardiology
- Neurology
- Medical Imaging
Background:
- Strokes can occur in patients with low CHADS₂ scores, with the left atrial appendage (LAA) being the source of emboli in 90% of cases.
- Left atrial appendage morphology is explored as a novel predictor for stroke risk.
Purpose of the Study:
- To determine if LAA anatomical characteristics can aid in stroke risk stratification for nonvalvular atrial fibrillation (AF) patients who have low CHADS₂ scores.
- To identify specific LAA morphologies associated with a history of stroke.
Main Methods:
- Contrast-enhanced computed tomography (CT) was used to analyze LAA anatomy in 80 AF patients undergoing catheter ablation.
- LAA morphology was classified into four types:
Main Results:
- No significant difference in average CHADS₂ scores between stroke patients and controls.
- A
Conclusions:
- Left atrial appendage anatomy, particularly the
Background:
Strokes develop even in patients with low CHADS₂ scores, and the left atrial appendage (LAA) is the embolic source 90% of the time. We focused on the LAA morphology as a new predictor of strokes.
Objective:
To clarify the anatomical characteristics of the LAA for risk stratification of strokes in patients with nonvalvular atrial fibrillation (AF) who have low CHADS₂ scores.
Methods:
Among 80 patients who underwent catheter ablation of AF with contrast-enhanced computed tomography, the LAA characteristics were compared between 30 patients with histories of strokes and 50 age-matched controls. The LAA anatomy was classified into 4 types--"cactus," "cauliflower," "chicken wing," and "windsock"--discriminated by the computed tomography measurements of the length, angle, and number of lobes of the LAA.
Results:
The average CHADS₂ score did not differ significantly between patients with stroke and controls (0.8 ± 0.8 vs 0.6 ± 0.7; P = .277). Eight (26.7%) patients with stroke had CHA₂DS₂-VASc scores of 0. The left atrial size, LAA flow velocity, left ventricular function, and serum brain natriuretic peptide level were also unable to predict strokes. However, a "cauliflower" LAA, defined as a main lobe of less than 4 cm long without forked lobes, was significantly more common in patients with stroke (odds ratio 3.857; 95% confidence interval 1.482-10.037; P = .005). The CHA₂DS₂-VASc score-adjusted logistic regression analysis revealed the cauliflower LAA as an independent predictor of a stroke (odds ratio 3.355; 95% confidence interval 1.243-9.055; P = .017).
Conclusions:
The LAA anatomy might be useful for predicting strokes in patients with nonvalvular AF who have low CHADS₂ scores.
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