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Updated: May 7, 2026
Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation
Published on: February 26, 2013
Left atrial appendage morphology and silent cerebral ischemia in patients with atrial fibrillation
Matteo Anselmino1, Marco Scaglione2, Luigi Di Biase3
1Division of Cardiology, Department of Medical Sciences, University of Turin, Turin, Italy.
Insights
Left atrial appendage morphology is linked to silent cerebral ischemia burden in atrial fibrillation patients. This finding may improve predicting stroke risk in AF using imaging techniques.
Area of Science:
- Cardiology
- Neurology
- Medical Imaging
Background:
- The left atrial appendage (LAA) is a primary source of cardiac thrombi in atrial fibrillation (AF).
- These thrombi significantly contribute to cardioembolic events.
Purpose of the Study:
- To explore the association between left atrial appendage (LAA) morphology and silent cerebral ischemia (SCI) burden.
- To evaluate SCI as a novel marker for thromboembolic risk in AF patients.
Main Methods:
- 348 AF patients undergoing transcatheter ablation were assessed.
- Cerebral MRI evaluated SCI burden; LAA morphology was assessed via MRI/CT.
- LAA morphologies were categorized: cactus, chicken wing, wind sock, and cauliflower.
Main Results:
- Silent cerebral ischemia (SCI) was detected in 84.8% of patients.
- LAA morphology significantly correlated with SCI burden (P = .035).
- Age, chicken wing, wind sock, and cauliflower morphologies were independently associated with SCI burden.
Conclusions:
- Left atrial appendage (LAA) morphology is associated with silent cerebral ischemia (SCI) burden in atrial fibrillation (AF) patients.
- Further research is needed to determine if echocardiography can assess LAA morphology for risk prediction.
Background:
Left atrial appendage (LAA) is the major source of cardiac thrombi in atrial fibrillation (AF) and plays a major role in cardioembolic events.
Objective:
To investigate the correlation between LAA morphology and the burden of silent cerebral ischemia (SCI) as a new thromboembolic risk marker in patients with AF.
Methods:
A total of 348 patients with AF undergoing transcatheter ablation were enrolled. A cerebral magnetic resonance (MR) was performed to assess SCI burden, while LAA morphology was studied by MR or computed tomography and categorized as follows: cactus in 52 (14.9%) patients, chicken wing in 177 (50.9%), wind sock in 101 (29.0%), and cauliflower in 18 (5.2%).
Results:
SCIs were detected in 295 (84.8%) patients, with a median number of lesions of 23. SCI burden was related to LAA complexity: 30.8% and 17.3% patients with cactus, 30.5% and 22.0% with chicken wing, 13.9% and 27.7% with wind sock, and 16.7% and 38.9% with cauliflower LAA morphologies were in the first and fourth quartiles of number of SCI per patient, respectively (P = .035). After adjustment for potential confounders, only age (β 0.12; 95% CI 0.08-0.16; P < .001), chicken wing (β -0.28; 95% CI -0.51 to -0.04; P = .021), wind sock (β 0.38; 95% CI 0.12-0.65; P = .005), and cauliflower (β 0.61; 95% CI 0.07-1.14; P = .026) LAA morphologies were significantly related to SCI burden.
Conclusion:
LAA morphology relates to the burden of SCI in AF patients. Future research should corroborate if accessible methods (eg, echocardiography) are able to describe LAA morphology, permitting its use within universal thromboembolic risk predictors in AF patients.
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