Clinical Characteristics of Non-Valvular Atrial Fibrillation Patients With a Large Left Atrial Appendage Ostium-Limiting Percutaneous Closure

• Published in: Circulation Journal Vol. 86; no. 8; pp. 1263 - 1272
• Main Authors: Machino-Ohtsuka, Tomoko, Nakagawa, Daishi, Albakaa, Noor K., Nakatsukasa, Tomofumi, Kawamatsu, Naoto, Sato, Kimi, Yamamoto, Masayoshi, Yamasaki, Hiro, Ishizu, Tomoko, Ieda, Masaki
• Format: Journal Article
• Language: English
• Published: Japan The Japanese Circulation Society 25.07.2022
• Subjects: Atrial Appendage - diagnostic imaging; Atrial Appendage - surgery; Atrial fibrillation; Atrial Fibrillation - complications; Atrial Fibrillation - surgery; Echocardiography; Echocardiography, Transesophageal; Humans; LAA closure; Left atrial appendage (LAA); Risk Factors; Stroke; Stroke - complications; Stroke - prevention & control; Thrombosis; LAA closure; Left atrial appendage (LAA); Stroke; Echocardiography; Atrial fibrillation
• ISSN: 1346-9843; 1347-4820; 1347-4820
• DOI: 10.1253/circj.CJ-22-0053

Background: The left atrial appendage (LAA) is a therapeutic target for preventing cardioembolic stroke in patients with non-valvular atrial fibrillation (NVAF). A large LAA ostium limits percutaneous LAA closure. This study investigated the characteristics and factors associated with a large LAA ostium in Japanese patients with NVAF.Methods and Results: In 1,102 NVAF patients, the maximum LAA diameter was measured using transesophageal echocardiography (TEE). A large LAA ostium was defined by a maximum diameter of >30 mm. Forty-four participants underwent repeated TEEs, and changes in LAA size under lasting AF were assessed. A large LAA ostium was observed in 3.1% of all participants and 8.9% of patients with long-standing persistent AF (LSAF). The large LAA group had greater CHA2DS2-VASc (P=0.024) and HAS-BLED scores (P=0.046) and a higher prevalence of LAA thrombus (P=0.004) than did the normal LAA group. LSAF, moderate or severe mitral regurgitation, left atrial volume ≥42 mL/m2, E/E’ ratio ≥9.5, and left ventricular mass ≥85 mg/m2were independently associated with a large LAA ostium (P<0.001, P<0.001, P=0.009, P=0.009, and P=0.032, respectively). In 44 patients with lasting AF, the LAA ostial diameter increased over time (P<0.001).Conclusions: NVAF patients with a large LAA ostium may have a higher risk of stroke and bleeding. LSAF and factors leading to LA overload may be closely associated with LAA ostial dilatation and can promote it.