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Updated: May 10, 2026
Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation
Published on: February 26, 2013
Left Atrial Appendage Morphology and Correlation With Stroke: A Narrative and Three-Dimensional Transesophageal
Sergio Suma1, Emiliano Guerra2, Rosi Vrenozaj3
1Department of Cardiology, University Hospital of Parma, Parma, Italy.
Insights
The left atrial appendage (LAA) is a key site for clot formation in atrial fibrillation (AF). Chicken-wing LAA morphology is linked to lower stroke risk, while other shapes indicate higher risk. Advanced 3D TEE aids LAA evaluation for stroke prevention.
Area of Science:
- Cardiology
- Medical Imaging
- Thrombosis Research
Background:
- The left atrial appendage (LAA) is the primary source of thrombus in non-valvular atrial fibrillation (AF).
- Clinical risk scores inadequately assess individual thromboembolic risk.
- LAA morphology and geometry offer prognostic insights beyond traditional factors.
Purpose of the Study:
- To review evidence linking LAA morphology to thromboembolic risk.
- To provide an overview of advanced 3D transesophageal echocardiography (3D TEE) for LAA assessment.
- To offer guidance on using 3D TEE for LAA evaluation and LAA occlusion (LAAO) planning.
Main Methods:
- Review of current literature on LAA morphology and stroke risk.
- Discussion of advanced 3D TEE techniques (en face visualization, multiplanar reconstruction, glass rendering).
- Focus on quantitative anatomical features (bend angle, distance, shape, volume) for improved reproducibility.
Main Results:
- Chicken wing (CW) LAA morphology is associated with significantly lower stroke risk compared to other configurations (cauliflower, cactus, windsock).
- Specific anatomical features like bend angle and ostial shape may be stronger predictors of thrombogenesis than qualitative shape.
- 3D TEE enables detailed, real-time, radiation-free assessment of LAA anatomy.
Conclusions:
- LAA morphology is a critical determinant of thromboembolic risk in AF patients.
- Advanced 3D TEE provides comprehensive, non-invasive LAA evaluation.
- Detailed LAA assessment with 3D TEE is essential for optimizing stroke risk stratification and planning LAA occlusion procedures.
Abstract:
The left atrial appendage (LAA) is the predominant site of thrombus formation in patients with non-valvular atrial fibrillation (AF). Accurate evaluation of LAA anatomy is therefore essential for both stroke risk stratification and procedural planning in LAA occlusion (LAAO). Although clinical scores such as CHA2DS2-VA guide anticoagulation strategies, they do not fully capture individual thromboembolic risk. Growing evidence indicates that LAA morphology and geometry provide incremental prognostic information beyond traditional clinical factors. Multiple studies have consistently demonstrated a lower stroke risk associated with the chicken wing (CW) morphology, whereas cauliflower, cactus, and windsock configurations are linked to higher thromboembolic risk. More recent investigations suggest that specific anatomical features-such as bend angle, ostium-to-bend distance, ostial shape, and LAA volume-may be stronger determinants of blood stasis and thrombogenesis than qualitative shape classification alone, with improved reproducibility. Most data on LAA morphology derive from cardiac computed tomography or magnetic resonance imaging. However, advances in three-dimensional transesophageal echocardiography (3D TEE), including en face visualization, multiplanar reconstruction, and glass rendering, now enable detailed, real-time, radiation-free assessment of LAA anatomy. This review summarizes current evidence linking LAA morphology to thromboembolic risk and provides a practical overview of advanced 3D TEE techniques for comprehensive LAA evaluation, with step-by-step guidance approach. The LAA is the primary site of thrombus formation in AF, and the chicken-wing morphology is associated with a lower risk of ischemic stroke compared with non-chicken-wing types. Advanced 3D TEE assessment is crucial for detailed morphological evaluation and for planning LAAO procedures. This review outlines how to evaluate the LAA using advanced 3D TEE techniques.
