Left Atrial Appendage Morphology Predicts Atrial Fibrillation Recurrence: The Hidden Risks of Windsock Anatomy

Area of Science:

• Cardiology
• Medical Imaging
• Electrophysiology

Background:

• Left atrial appendage (LAA) morphology is suspected to influence atrial fibrillation (AF) recurrence post-catheter ablation.
• The specific predictive value of distinct LAA anatomical shapes requires further clarification.

Purpose of the Study:

• To investigate the association between different LAA morphologies and the rate of AF recurrence after catheter ablation.
• To identify LAA shapes as independent predictors of AF recurrence.

Main Methods:

• Retrospective analysis of 463 patients with AF undergoing first-time catheter ablation.
• LAA morphology classified into four types (chicken-wing, windsock, cauliflower, cactus) using pre-ablation cardiac CT.
• One-year follow-up to assess AF recurrence, defined as atrial tachyarrhythmia >30s between 3-12 months post-procedure.

Main Results:

• Windsock-type LAA exhibited the highest AF recurrence rate (48.3%), significantly higher than other types (p=0.017).
• Multivariable analysis identified windsock morphology (aOR=2.720) as an independent predictor of recurrence.
• Persistent AF and antiarrhythmic drug use during the blanking period also independently predicted recurrence.

Conclusions:

• Windsock-type LAA morphology is a significant predictor of increased AF recurrence following catheter ablation.
• Incorporating LAA morphological assessment into ablation planning may enhance procedural outcomes.
• Personalized ablation strategies targeting high-risk LAA morphologies could improve success rates and reduce AF recurrence.