Abstract
Background: Left atrial accessory appendages (LAAA) and left atrial diverticula (LAD) may be caused by structural remodeling. The aim of our study is therefore to investigate the relation between the occurrence of LAAA/LAD, different types of atrial fibrillation (AF) and cardiovascular risk factors affecting the atrial structure including age, diabetes mellitus, hypertension, and hypercholesterolemia, body mass index (BMI) and sex. To our knowledge, the relation between the occurrence of LAAA and LAD and cardiovascular risk factors has not yet been studied.
Methods: Cardiac CT scans were obtained from patients with sinus rhythm (N=402, SR) and a history of AF (N=422, AF) for evaluation of either coronary artery disease or atrial anatomy prior to pulmonary vein isolation (PVI) and were screened for the presence of LAD and LAAA. Clinical characteristics including cardiovascular risk factors were retrieved from the electronic medical records and correlated with the presence of LAAA/LAD.
Results: In 91 (22.6%) SR patients, a total of 90 LAAA and 4 LAD were detected and in the AF group (N=74, 17.5%), 75 LAAA and 2 LAD. LAAA/LAD prevalence did not differ between SR and AF patients (P=.067) nor between patients with paroxysmal and persistent AF (P=0 .924) Also,
there was no relation was detected between LAAA/LAD prevalence and cardiovascular risk factors (P > .05).
Conclusion: The prevalence of LAAA/LAD in a large patient cohort was not associated with clinical profiles including AF subtypes and cardiovascular risk factors affecting atrial structure. Hence, it is unlikely that LAAA/LAD play an important role in the pathophysiology of AF.
Abbreviations: A: Anterior, AF: Atrial Fibrillation, AO: Aorta, BMI: Body Mass Index, CT: Computed Tomography, L: Left, LA: Left Atrium, LAA: Left Atrial Appendage, LAAA: Left Atrial Accessory Appendage, LAD: Left Atrial Diverticula, LSPV: Left Superior Pulmonary Vein, LIPV: Left
Inferior Pulmonary Vein, P: Posterior, R: Right, RSPV: Right Superior Pulmonary Vein, RIPV: Right Inferior Pulmonary Vein, SR: Sinus Rhythm.
Keywords
Electrophysiology, Atrial Fibrillation, Pathophysiology, Left Atrial Accessory Appendages, Left atrial Diverticula, CT imaging