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Evaluation of left atrial appendage anatomy and function in recent-onset atrial fibrillation by transesophageal
D N Rubin1, S E Katz, M F Riley
1Cardiovascular Division, Beth Israel Hospital and Harvard Medical School, Boston, Massachusetts, USA.
Insights
Newly diagnosed atrial fibrillation (AF) patients with thrombi show enlarged left atrial (LA) and appendage anatomy, alongside reduced outflow velocities. This suggests rapid LA remodeling occurs early in AF.
Area of Science:
- Cardiology
- Medical Imaging
Background:
- Limited data exists on left atrial (LA) and LA appendage anatomy/function in newly recognized atrial fibrillation (AF) patients without prior warfarin.
- Understanding these factors is crucial for identifying risks of thrombus formation.
Purpose of the Study:
- To identify echocardiographic indexes predicting thrombus formation in treatment-naive, newly recognized AF patients.
- To characterize LA and LA appendage anatomy and function in this cohort.
Main Methods:
- Transesophageal echocardiography was performed on 100 consecutive patients with newly recognized AF (duration 2.6 +/- 0.3 weeks) who had not received long-term warfarin.
- Analysis focused on LA and LA appendage size, outflow velocities, and spontaneous echo contrast.
Main Results:
- Fourteen percent of patients had LA thrombi, associated with larger LA appendages, reduced outflow velocities, and severe spontaneous LA contrast.
- Spontaneous contrast correlated with larger LA/appendage dimensions and lower ejection velocity.
- Patients with AF <2 weeks showed greater appendage velocities and smaller LA/appendage sizes compared to those with AF >2 weeks.
Conclusions:
- Patients with recent-onset AF and LA thrombi or spontaneous echo contrast exhibit more dilated LA and LA appendage anatomy.
- Depressed LA appendage systolic function is observed in these patients.
- Findings suggest AF is associated with rapid LA remodeling, even in the early stages.
Abstract:
Data regarding left atrial (LA) and LA appendage anatomy and function among patients with newly recognized atrial fibrillation (AF) who have not received long-term warfarin are currently unknown. To identify echocardiographic indexes which characterize those at increased risk for thrombus formation, we analyzed transesophageal echocardiographic studies in 100 consecutive patients with newly recognized AF (duration 2.6 +/- 0.3 week) who had not received long-term warfarin. Fourteen percent of patients had LA thrombi. LA thrombi were associated with larger LA appendages, more depressed LA appendage outflow velocities, and a higher prevalence of severe spontaneous LA contrast. Patients with spontaneous contrast had larger LA and LA appendage anatomy and lower LA appendage ejection velocity. Among patients presenting with their first episode of AF, greater LA appendage ejection and filling velocities and smaller LA and LA appendage sizes were seen among those with AF of <2 weeks duration compared with those with AF of >2 weeks. Thus, patients with recent onset AF and LA thrombi or spontaneous echo contrast have more dilated LA and LA appendage anatomy, and more depressed LA appendage systolic function. Data from patients with their first episode of AF suggests that AF is associated with rapid LA remodeling.