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Updated: Dec 29, 2025
Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation
Published on: February 26, 2013
Left Atrial Appendage Morphology as a Determinant for Stroke Risk Assessment in Atrial Fibrillation Patients:
Abu Rmilah Anan1, Jumah Fareed2, Jaber Suhaib3
1Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA.
Insights
The chicken wing (CW) left atrial appendage (LAA) morphology is associated with a significantly lower risk of cerebrovascular accident (CVA) in atrial fibrillation (AF) patients compared to other LAA shapes. This finding aids in CVA risk stratification for AF patients.
Area of Science:
- Cardiology
- Neurology
- Medical Imaging
Background:
- Atrial fibrillation (AF) is a primary cause of emboli leading to cerebrovascular accidents (CVA).
- Left atrial appendage (LAA) morphology is implicated in the pathogenesis of CVA in AF patients.
- Understanding LAA morphology's role in CVA risk is crucial for patient management.
Purpose of the Study:
- To investigate the association between LAA morphology and CVA occurrence in patients with AF.
- To compare the risk of CVA in patients with chicken wing (CW) LAA morphology versus other LAA morphologies.
Main Methods:
- A systematic review and meta-analysis of studies published between 2010-2018 was conducted.
- Included studies analyzed LAA morphology (CW, cauliflower, cactus, windsock) using 3D TEE, MDCT, or CMRI in AF patients.
- Risk ratios (RR) for CVA were calculated and statistically analyzed using forest plots.
Main Results:
- Twelve studies involving 3486 AF patients were included.
- Patients with CW LAA morphology had a 41% lower risk of CVA compared to non-CW morphologies (RR=0.59).
- The risk of CVA was significantly lower in CW patients compared to cauliflower, cactus, and windsock morphologies.
Conclusions:
- Non-chicken wing LAA morphologies are associated with a higher incidence of CVA in AF patients.
- LAA morphology, particularly the chicken wing shape, can be a valuable tool for CVA risk stratification in AF patients.
- Further research can refine risk prediction models incorporating LAA morphology.
Background:
Atrial fibrillation (AF) is a leading source of emboli that precipitate cerebrovascular accident (CVA) which is correlated with left atrial appendage (LAA) morphology. We aimed to elaborate the relationship between CVA and LAA morphology in AF patients.
Methods:
Medline and EMBASE databases were thoroughly searched between 2010-2018 for studies that included atrial fibrillation patients and classified them into two groups based on CVA occurrence. Four different LAA morphologies (Chicken wing CW, Cauliflower, cactus and windsock) were determined in each group by 3D TEE, MDCT or CMRI. New Castle Ottawa Scale was used to appraise the quality of included studies. The risk of CVA before cardiac ablation and/or LAA intervention in CW patients was compared to each type of non-CW morphologies. The extracted data was statistically analyzed in the form of forest plot by measuring the risk ratio (RR) using REVMAN software. P value and I square were used to assess the heterogeneity between studies.
Results:
PRISMA diagram was illustrated showing 789 imported studies for screening. Three duplicates were removed, and the rest were arbitrated by 2 reviewers yielding 12 included studies with 3486 patients including 1551 with CW, 442 with cauliflower, 732 with cactus 765 with windsock. The risk of CVA in CW patients was reduced by 41% relative to non-CW patients (Total RR=0.59 (0.52-0.68)). Likewise, the risk of CVA in CW patients was less by 46%, 35% and 31% compared to cauliflower (Total RR =0.54(0.46-0.64)), cactus (Total RR =0.65(0.55-0.77)) and windsock (Total RR =0.69(0.58-0.83)) patients respectively. Low levels of heterogeneity were achieved in all comparisons (I square <35% and p value > 0.1).
Conclusions:
Patients with non-CW morphologies (cauliflower, cactus and windsock) show a higher incidence of CVA than CW patients. For that reason, LAA appendage morphology could be useful for risk stratification of CVA in AF patients.
