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Left Atrial Appendage Characteristics Assessed with Cardiac Computed Tomography in Patients with Atrial Fibrillation

Hee Jeong Lee1, Jiwon Seo2, Kyu Kim3

  • 1Division of Cardiology, Keimyung University Dongsan Hospital, Daegu, Korea.

Yonsei Medical Journal
|August 28, 2025
PubMed

Insights

Left atrial appendage (LAA) morphology in atrial fibrillation (AF) patients with severe mitral valve (MV) disease shows distinct patterns, with higher rates of stasis and thrombus, particularly in mitral stenosis.

Area of Science:

  • Cardiology
  • Radiology
  • Medical Imaging

Background:

  • Left atrial appendage (LAA) characteristics are crucial in non-valvular atrial fibrillation (AF).
  • Limited data exists on LAA morphology and function in patients with mitral valve (MV) disease.
  • Understanding LAA in MV disease is vital for AF management.

Purpose of the Study:

  • To investigate the morphological and functional characteristics of the LAA in AF patients with severe MV disease.
  • To compare LAA variables based on the predominant type of MV dysfunction.

Main Methods:

  • Retrospective analysis of 506 AF patients undergoing cardiac computed tomography (CT) for MV surgery.
  • Assessment of LAA morphology (cactus, cauliflower, windsock, chicken wing), ostium diameter, volume, and presence of stasis or thrombus.
  • Comparison of LAA variables between patients with predominant mitral stenosis versus mitral regurgitation.

Main Results:

  • Cactus morphology was most common (41.7%), followed by cauliflower (28.3%).
  • Average LAA ostium diameter was 35.3±8.0 mm; average LAA volume was 22.1±15.1 mL.
  • LAA stasis (42.5%) and thrombus (18.4%) were prevalent. Patients with predominant mitral stenosis had smaller LAA volumes but significantly higher rates of LAA stasis (71.7%) and thrombus (33.6%) compared to those with mitral regurgitation.

Conclusions:

  • LAA remodeling in AF patients with severe MV disease leads to a different morphologic distribution compared to patients without MV disease.
  • Severe MV disease significantly impacts LAA characteristics, increasing risks of stasis and thrombus formation.
  • These findings highlight the importance of evaluating LAA in the context of MV disease for improved stroke risk stratification and management.
Abstract

Keywords:
Left atrial appendageatrial fibrillationcomputed tomographymitral valve disease

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