Relation of a Filling Defect of Left Atrial Appendage by Contrast Computed Tomography Image With Subsequent Clinical...

Area of Science:

• Cardiology
• Radiology
• Medical Imaging

Background:

• Filling defects (FD) in the left atrial appendage (LAA) are common in contrast computed tomography (CT) for atrial fibrillation (AF) patients.
• The prognostic significance of LAA FD in AF patients undergoing ablation remains underexplored.

Purpose of the Study:

• To investigate the prognostic impact of LAA FD on long-term clinical outcomes in patients undergoing AF ablation.
• To assess the association between LAA FD severity and recurrence of atrial tachyarrhythmias and major adverse cardiovascular events (MACEs).

Main Methods:

• 1,019 consecutive patients undergoing AF ablation with baseline contrast CT were enrolled.
• LAA FD was graded (0: complete filling, 1: incomplete, 2: complete FD).
• Long-term outcomes, including atrial tachyarrhythmias and MACEs, were evaluated over a mean follow-up of 4.4 years.

Main Results:

• Grade 2 FD was associated with nonparoxysmal AF, higher brain natriuretic peptide, and larger left atrial volume.
• The 5-year cumulative incidence of recurrent atrial tachyarrhythmias was significantly higher in grade 2 FD patients (74.0%) compared to grade 0/1 (38.8%/62.1%).
• The 5-year cumulative incidence of MACEs was significantly higher in grade 2 FD patients (19.4%) versus grade 0/1 (5.6%/9.5%). Residual grade 2 FD at follow-up also increased MACE risk.

Conclusions:

• Severe LAA FD in contrast CT is a significant predictor of higher arrhythmia recurrence and MACEs in AF patients undergoing catheter ablation.
• LAA FD grading provides valuable prognostic information for risk stratification in this patient population.
• Further research may explore interventions to mitigate risks associated with LAA FD.