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Tsuji T, Hasegawa K, Tada H. Left atrial diverticulum as a rare but possible origin of a sustained atrial tachycardia: a case report. Eur Heart J 2024; 45:2679. [PMID: 38805689 DOI: 10.1093/eurheartj/ehae317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/30/2024] Open
Affiliation(s)
- Toshihiko Tsuji
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, University of Fukui, 23-3 Matsuokashimoaizuki, Eiheiji-cho, Yoshida-gun, Fukui 910-1193, Japan
| | - Kanae Hasegawa
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, University of Fukui, 23-3 Matsuokashimoaizuki, Eiheiji-cho, Yoshida-gun, Fukui 910-1193, Japan
| | - Hiroshi Tada
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, University of Fukui, 23-3 Matsuokashimoaizuki, Eiheiji-cho, Yoshida-gun, Fukui 910-1193, Japan
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Mitsuishi A, Miura Y, Nomura Y, Hirota T, Arima N, Kitaoka H, Tateiwa H, Katsumata Y. Bleeding sites and treatment strategies for cardiac tamponade by catheter ablation requiring thoracotomy: risks of catheter ablation in patients with left atrial diverticulum. J Cardiothorac Surg 2024; 19:238. [PMID: 38632637 PMCID: PMC11022316 DOI: 10.1186/s13019-024-02710-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 03/29/2024] [Indexed: 04/19/2024] Open
Abstract
BACKGROUND There is insufficient information regarding the bleeding sites and surgical strategies of cardiac tamponade during catheter ablation for atrial fibrillation (AF). CASE PRESENTATION Of the five patients with cardiac tamponade, three required surgical intervention and two required pericardiocentesis. In the first case of three cardiac tamponades requiring surgical intervention, considering that the peripheral route was used, the catecholamines did not reach the heart, and due to unstable vital signs, venoarterial extracorporeal membrane oxygenation (VA-ECMO) was inserted. No bleeding point was identified, but a thrombus had spread around the left atrium (LA) with diverticulum. Hemostasis was achieved with adhesives placed around the LA under on-pump beating. In the second case, pericardiocentesis was performed, but the patient showed heavy bleeding and unstable vital signs. Thus, VA-ECMO was inserted. Heavy bleeding was expected, and safety was enhanced by attaching a reservoir to the VA-ECMO. The bleeding point was found between the left upper pulmonary artery and LA under cardiac arrest to obtain a good surgical view for suturing repair. In the third case, the LA diverticulum was damaged. Pericardiocentesis resulted in stable vitals, but sustained bleeding was present. A bleeding point was found at the LA diverticulum, and suture repair under on-pump beating was performed. CONCLUSIONS When cardiac tamponade occured in any patient with LA diverticulum, treatment could not be completed with pericardiocentesis alone, and thoracotomy was likely to be necessary. If the bleeding point could be confirmed, suturing technique is a more reliable surgical strategy than adhesive alone that leads to pseudoaneurysm. If the bleeding point is unclear, it is important to confirm the occurrence of LA diverticulum using a preoperative CT, and if confirmed, cover it with adhesive due to a high possibility of diverticulum bleeding. The necessity of CPB should be determined based on whether these operations can be completed while maintaining vital stability.
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Affiliation(s)
- Atsuyuki Mitsuishi
- Department of Cardiovascular Surgery, Kochi Medical School Hospital, 185-1, Kohasu, Okohmachi, Nankoku-shi, Kochi Prefecture, 783-8505, Japan.
| | - Yujiro Miura
- Department of Cardiovascular Surgery, Kochi Medical School Hospital, 185-1, Kohasu, Okohmachi, Nankoku-shi, Kochi Prefecture, 783-8505, Japan
| | - Yoshinori Nomura
- Department of Clinical Engineering, Kochi Medical School Hospital, 185-1, Kohasu, Okohcho, Nankoku-shi, Kochi Prefecture, 783-8505, Japan
| | - Takayoshi Hirota
- Department of Cardiology and Geriatrics, Kochi Medical School Hospital, 185-1, Kohasu, Okohmachi, Nankoku-shi, Kochi Prefecture, 783-8505, Japan
| | - Naoki Arima
- Department of Cardiology and Geriatrics, Kochi Medical School Hospital, 185-1, Kohasu, Okohmachi, Nankoku-shi, Kochi Prefecture, 783-8505, Japan
| | - Hiroaki Kitaoka
- Department of Cardiology and Geriatrics, Kochi Medical School Hospital, 185-1, Kohasu, Okohmachi, Nankoku-shi, Kochi Prefecture, 783-8505, Japan
| | - Hiroki Tateiwa
- Department of Anesthesiology and Intensive Care Medicine, Kochi Medical School, 185-1, Kohasu, Okohmachi, Nankoku-shi, Kochi Prefecture, 783-8505, Japan
| | - Yoshifumi Katsumata
- Department of Anesthesiology and Intensive Care Medicine, Kochi Medical School, 185-1, Kohasu, Okohmachi, Nankoku-shi, Kochi Prefecture, 783-8505, Japan
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Ratusznik J, Ratusznik F, Pękala JR, Krager E, Hołda M, Sarata V, Łazarz D, Raputa W, Tomaszewski KA. A meta-analysis of the accessory left atrial appendage and the left atrial diverticulum. Clin Anat 2024; 37:294-303. [PMID: 37621227 DOI: 10.1002/ca.24110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2022] [Revised: 06/22/2023] [Accepted: 07/31/2023] [Indexed: 08/26/2023]
Abstract
Left atrial (LA) structures, including the accessory left atrial appendage (aLAA) and left atrial diverticulum, have been studied based on their prevalence, shape, and association with arrhythmia and thrombi formation. A pooled prevalence with morphometric data has not been determined in previous research. Our goal is to provide structured, clinically relevant information on said structures for clinical practitioners to use in their daily work. We propose that morphometric data of additional LA structures is necessary when considering the possible complications during cardiac interventions. We conducted a meta-analysis of all relevant studies which used electrocardiogram (ECG)-gated computed tomography (CT) imaging to determine the prevalence of LA structures and record their morphometric characteristics as well as the presence of thrombi. Data were extracted from 19 studies (n = 6643 hearts). The pooled prevalence estimate of left atrial diverticulum and/or aLAAs were reported from 14 studies and was 28.8%. The most common location noted was anterosuperior in the LA with 70.2% of structures found there. Data regarding thrombi presence in left atrial diverticulums or aLAAs were extracted from 11 studies and a thrombus was present in 0.2%. The prevalence rates of aLAAs and left atrial diverticulums are essential in performing uncomplicated cardiac interventions and reducing risk of electrophysiological procedures. Our findings show a considerable prevalence of LA structures in varying populations, provides information regarding the general characteristics of said structures, and does not support the previously theorized associated risk of thrombus formation in relation to LA structure presence.
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Affiliation(s)
- Jakub Ratusznik
- International Evidence-Based Anatomy Working Group, Krakow, Poland
- Department of Anatomy, Jagiellonian University Medical College, Krakow, Poland
| | - Filip Ratusznik
- International Evidence-Based Anatomy Working Group, Krakow, Poland
- Department of Anatomy, Jagiellonian University Medical College, Krakow, Poland
| | - Jakub R Pękala
- International Evidence-Based Anatomy Working Group, Krakow, Poland
- Department of Anatomy, Jagiellonian University Medical College, Krakow, Poland
| | - Eirik Krager
- International Evidence-Based Anatomy Working Group, Krakow, Poland
- Department of Anatomy, Jagiellonian University Medical College, Krakow, Poland
| | - Mateusz Hołda
- International Evidence-Based Anatomy Working Group, Krakow, Poland
- Department of Anatomy, Jagiellonian University Medical College, Krakow, Poland
- Division of Cardiovascular Sciences, The University of Manchester, Manchester, UK
| | - Victoria Sarata
- International Evidence-Based Anatomy Working Group, Krakow, Poland
- Department of Anatomy, Jagiellonian University Medical College, Krakow, Poland
| | - Dominik Łazarz
- International Evidence-Based Anatomy Working Group, Krakow, Poland
- Department of Anatomy, Jagiellonian University Medical College, Krakow, Poland
| | - Wiktor Raputa
- International Evidence-Based Anatomy Working Group, Krakow, Poland
- Department of Anatomy, Jagiellonian University Medical College, Krakow, Poland
| | - Krzysztof A Tomaszewski
- International Evidence-Based Anatomy Working Group, Krakow, Poland
- Department of Anatomy, Jagiellonian University Medical College, Krakow, Poland
- Andrzej Frycz Modrzewski Krakow University, Kraków, Poland
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Takeuchi H. Left Atrial Diverticula Present in the Right Lower Pulmonary Vein Thrombus Attachment Area. Cureus 2024; 16:e53422. [PMID: 38314379 PMCID: PMC10835019 DOI: 10.7759/cureus.53422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/01/2024] [Indexed: 02/06/2024] Open
Abstract
Left atrial diverticula (LADs) are thought to be associated with atrial fibrillation and an ischemic brain state. However, the mechanisms of LAD formation are unknown. Pulmonary vein thrombi (PVTs) can cause acute myocardial infarction (AMI) and ischemic stroke by releasing rather large particles. Additionally, PVTs can release much smaller particles, including neutrophil extracellular traps (NETs) and/or other components of NETs, such as DNA and histones. To treat these diseases, it may be crucial to know the specific traits of PVTs. However, these issues are not direct effects of PVTs on the left atrium (LA). It is unclear whether PVTs affect the LA directly. We checked the direct effects of PVTs on the LA using cardiac computed tomography (CT) and transesophageal echocardiography (TEE). The patient was a 73-year-old female with hypertension. TEE revealed extended LA thrombi from the right lower pulmonary vein, which were attached to the anterosuperior wall of the LA. Cardiac CT revealed the attaching area as a defect of enhancement and dimly revealed LAD with full thrombi on the attaching area. It was difficult to recognize the LAD at first; however, after one month of standard-dose heparin-warfarin treatment, the LAD was clearly detected using cardiac CT. LA thrombi could not be detected using cardiac CT.
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Affiliation(s)
- Hidekazu Takeuchi
- Internal Medicine (Cardiology), Takeuchi Naika Clinic, Ogachi-Gun, JPN
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Goertz L, Nelles C, Pennig L, Bunck AC, Reimer RP, Fervers P, Kabbasch C, Maintz D, Celik E. Association between pouch morphology, cardiovascular risk factors and ischemic brain lesions in patients with left-sided septal pouches. Clin Imaging 2023; 100:36-41. [PMID: 37196503 DOI: 10.1016/j.clinimag.2023.04.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Revised: 04/03/2023] [Accepted: 04/24/2023] [Indexed: 05/19/2023]
Abstract
BACKGROUND Left atrial outpouching structures such as left atrial diverticula (LADs) and left-sided septal pouches (LSSPs) might be a source of cryptogenic stroke. This imaging study evaluates the association between pouch morphology, patient comorbidities and ischemic brain lesions (IBLs). METHODS This is a retrospective single-center analysis of 195 patients who received both a cardiac CT and a cerebral MRI. LADs, LSSPs, and IBLs were retrospectively identified. Size measurements included pouch width, length and volume for LADs and circumference, area and volume for LSSPs. The association between LADs/LSSPs, IBLs and cardiovascular comorbidities was determined by univariate and bivariate regression analyses. RESULTS The prevalence and mean volume were 36.4% and 372 ± 569 mm3 for LSSPs, and 40.5% and 415 ± 541 mm3 for LADs. The IBL prevalence was 67.6% in the LSSP group and 48.1% in the LAD group. LSSPs had 2.9-fold increased hazards of IBLs (95%CI: 1.2-7.4, p = 0.024), and LADs showed no significant correlation with IBLs. Size measurements had no impact on IBLs. A co-existing LSSP was associated with an increased prevalence of IBLs in patients with coronary artery disease (HR: 1.5, 95%CI: 1.1-1.9, p = 0.048), heart failure (HR: 3.7, 95%CI: 1.1-14.6, p = 0.032), arterial hypertension (HR: 1.9, 95%CI: 1.1-3.3, p = 0.017), and hyperlipidemia (HR: 2.2, 95%CI: 1.1-4.4, p = 0.018). CONCLUSION Co-existing LSSPs were associated with IBLs in patients with cardiovascular risk factors, however, pouch morphology did not correlate with the IBL rate. Upon confirmation by further studies, these findings might be considered in the treatment, risk stratification, and stroke prophylaxis of these patients.
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Affiliation(s)
- Lukas Goertz
- University of Cologne, Faculty of Medicine and University Hospital, Department of Radiology and Neuroradiology, Cologne, Germany.
| | - Christian Nelles
- University of Cologne, Faculty of Medicine and University Hospital, Department of Radiology and Neuroradiology, Cologne, Germany
| | - Lenhard Pennig
- University of Cologne, Faculty of Medicine and University Hospital, Department of Radiology and Neuroradiology, Cologne, Germany
| | - Alexander Christian Bunck
- University of Cologne, Faculty of Medicine and University Hospital, Department of Radiology and Neuroradiology, Cologne, Germany
| | - Robert Peter Reimer
- University of Cologne, Faculty of Medicine and University Hospital, Department of Radiology and Neuroradiology, Cologne, Germany
| | - Philipp Fervers
- University of Cologne, Faculty of Medicine and University Hospital, Department of Radiology and Neuroradiology, Cologne, Germany
| | - Christoph Kabbasch
- University of Cologne, Faculty of Medicine and University Hospital, Department of Radiology and Neuroradiology, Cologne, Germany
| | - David Maintz
- University of Cologne, Faculty of Medicine and University Hospital, Department of Radiology and Neuroradiology, Cologne, Germany
| | - Erkan Celik
- University of Cologne, Faculty of Medicine and University Hospital, Department of Radiology and Neuroradiology, Cologne, Germany
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Is there an association between left atrial outpouching structures and recurrence of atrial fibrillation after catheter ablation? PLoS One 2022; 17:e0276369. [PMID: 36301863 PMCID: PMC9612428 DOI: 10.1371/journal.pone.0276369] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Accepted: 10/05/2022] [Indexed: 11/05/2022] Open
Abstract
Objective The aim of this study was to investigate the impact of left atrial diverticula (LADs), left sided septal pouches (LSSPs) and middle right pulmonary veins (MRPVs) on recurrent atrial fibrillation (rAF) in patients undergoing laser pulmonary vein isolation procedure (PVI). Material and methods This retrospective study enrolled 139 patients with pre-procedural multiple detector computed tomography (MDCT) imaging and 12 months follow-up examination. LADs, LSSPs and MRPV were identified by two radiologists on a dedicated workstation using multiplanar reconstructions and volume rendering technique. Univariate and bivariate regression analyses with patient demographics and cardiovascular risk factors as covariates were performed to reveal independent factors associated with rAF. Results LADs were recorded in 41 patients (29%), LSSPs in 20 (14%) and MRPVs in 15 (11%). The right anterosuperior wall of the left atrium was the most prevalent location of LADs (68%). rAF occured in 20 patients, thereof, 15 exhibited an outpouching structure of the left atrium (LAD: 9, LSSP: 2 and MRPV: 3). Presence of an LAD (HR: 2.7, 95%CI: 1.0–8.4, p = 0.04) and permanent AF (HR: 4.8, 95%CI: 1.5–16.3, p = 0.01) were independently associated with rAF. Conclusions LAD, LSSP and MRPV were common findings on pre-procedural cardiac computed tomography. LADs were revealed as potential independent risk factor of rAF, which might be considered for treatment planning and post-treatment observation.
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Atrial fibrillation ablation: the position of computed tomography in pre-procedural imaging. CURRENT ISSUES IN PHARMACY AND MEDICAL SCIENCES 2022. [DOI: 10.2478/cipms-2022-0022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Abstract
Atrial fibrillation (AF) is the most common supraventricular arrhythmia. Despite significant advances in its treatment, it still remains one of the leading causes of cardiovascular morbidity and mortality. In the last two decades, pulmonary vein isolation (PVI) was developed as the most effective treatment option. The reported effectiveness of a single ablation procedure ranges from 40% to 69% with single, and up to 88% with repeated procedures, with acceptable safety profile. The PubMed database was searched, using terms including ‘atrial fibrillation ablation’, ‘pulmonary vein isolation’, ‘computed tomography’, ‘pulmonary vein anatomy’ and ‘ovality index’. Papers were reviewed for relevance and scientific merit. Different imaging techniques are used for pre-procedural assessment of left atrial (LA) anatomy, of which computed tomography (CT) is the most common. It allows assessing pulmonary vein (PV) anatomy, the LA wall thickness in different regions and the left atrial appendage (LAA) anatomy, together with excluding the presence of intracardiac thrombi. Pre-procedural PVs imaging is important regardless of the selected ablation technique, however, cryoballoon (CB) ablation seems to be particularly anatomy-dependent. Additionally, CT also permits assessment of several PVs characteristics (geometry, dimensions, angulations, the ostium area, orientation and ovality index (OI), which are essential for the patients’ qualification and designing the strategy of AF ablation. In this paper, we have reviewed the role of CT imaging in patients undergoing ablation procedure due to recurrent/symptomatic atrial fibrillation. Moreover, we discussed the relevant literature.
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Şimşek S, Özmen CA, Kansu Y. Cardiac CT evaluation of left atrial diverticulum and accessory appendage. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2022. [DOI: 10.1186/s43055-022-00873-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
The aim of this study was to evaluate the prevalence, location, size, and morphological features of the left atrial accessory appendage and diverticulum with cardiac computed tomography. Cardiac computed tomography obtained consecutively from 1415 patients with normal ECG findings during a 2-year period were analyzed. Left atrial appendage and diverticulum type, location, and size were recorded and analyzed according to age and gender.
Results
Cardiac computed tomography of 1415 (796 males and 619 females) participants aged 44.1 + 12.2 years old were re-evaluated, and 238 atrial diverticulum were found in 234 (16.5%) patients, accessory appendage in 93 (6.5%), and atrial diverticula and accessory appendage together in eight (0.56%) patients. The atrial diverticulum was most frequently observed in the anterosuperior localization (n = 157, 49.2%). One hundred and twenty-three (52%) of the atrial diverticulum were cystic, and 107 (45%) were tubular form. Accessory appendage was observed most frequently in the anterior superior location (n = 65, 20.4%).
Conclusions
The frequency of left atrial diverticulum was found to be 16%, and the frequency of accessory appendage was 6%, consistent with the majority of the literature. Left atrial diverticulum and accessory appendage were detected more frequently in men than in women. Cystic form is more common in left atrial diverticulum.
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Hasebe H, Furuyashiki Y, Yoshida K. Epicardial bypass tract at the left atrial diverticulum. Eur Heart J Case Rep 2021; 5:ytab099. [PMID: 34113772 PMCID: PMC8186926 DOI: 10.1093/ehjcr/ytab099] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 01/13/2021] [Accepted: 02/25/2021] [Indexed: 11/14/2022]
Affiliation(s)
- Hideyuki Hasebe
- Department of Cardiology, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba 305-8575, Japan
- Division of Arrhythmology, Shizuoka Saiseikai General Hospital, 1-1-1 Oshika, Suruga-ku, Shizuoka 422-8527, Japan
| | - Yoshitaka Furuyashiki
- Division of Arrhythmology, Shizuoka Saiseikai General Hospital, 1-1-1 Oshika, Suruga-ku, Shizuoka 422-8527, Japan
| | - Kentaro Yoshida
- Department of Cardiology, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba 305-8575, Japan
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Schneider M, Morris DA, Pieske-Kraigher E, Walter-Rittel T, Parwani AS, Pieske B, Boldt LH. Left atrial diverticulum-An unexpected finding in routine transesophageal echocardiography. Echocardiography 2020; 38:147-148. [PMID: 33280163 DOI: 10.1111/echo.14949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Revised: 11/10/2020] [Accepted: 11/15/2020] [Indexed: 11/29/2022] Open
Abstract
We report a 55-year-old male patient with lone paroxysmal atrial fibrillation who underwent routine transesophageal echocardiography (TOE) at our institution. In a mid-esophageal 125° three-chamber angulation, a distinct thinning of the left atrial (LA) wall was observed, forming a 7 × 4 mm canal with only a small membrane separating the LA from the pericardial space. Cardiac magnetic resonance imaging diagnosed a small LA diverticulum. To the best of our knowledge, this is the first manuscript describing detection of a small LA diverticulum via TOE.
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Affiliation(s)
- Matthias Schneider
- Department of Internal Medicine and Cardiology, Charité University Medicine (Campus Virchow Klinikum), Berlin, 13353, Germany
| | - Daniel A Morris
- Department of Internal Medicine and Cardiology, Charité University Medicine (Campus Virchow Klinikum), Berlin, 13353, Germany
| | - Elisabeth Pieske-Kraigher
- Department of Internal Medicine and Cardiology, Charité University Medicine (Campus Virchow Klinikum), Berlin, 13353, Germany
| | - Thula Walter-Rittel
- Department of Radiology, Charité-Universitaetsmedizin Berlin, Berlin, Germany
| | - Abdul S Parwani
- Department of Internal Medicine and Cardiology, Charité University Medicine (Campus Virchow Klinikum), Berlin, 13353, Germany
| | - Burkert Pieske
- Department of Internal Medicine and Cardiology, Charité University Medicine (Campus Virchow Klinikum), Berlin, 13353, Germany
| | - Leif-Hendrik Boldt
- Department of Internal Medicine and Cardiology, Charité University Medicine (Campus Virchow Klinikum), Berlin, 13353, Germany
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Celik E, Pennig L, Laukamp KR, Hammes J, Maintz D, Kabbasch C, Abdullayev N, Bunck AC, Achenbach T, Caldeira L, Hickethier T. Are left atrial diverticula and left-sided septal pouches relevant additional findings in cardiac CT? Correlation between left atrial outpouching structures and ischemic brain alterations. Int J Cardiol 2020; 317:216-220. [DOI: 10.1016/j.ijcard.2020.05.038] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Revised: 04/11/2020] [Accepted: 05/13/2020] [Indexed: 10/24/2022]
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12
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Veen D, Bruning TA, de Groot NMS. Left atrial diverticula: Innocent bystanders or wolves in sheep's clothing? J Cardiovasc Electrophysiol 2020; 31:2484-2488. [PMID: 32445428 DOI: 10.1111/jce.14581] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 05/04/2020] [Accepted: 05/18/2020] [Indexed: 11/29/2022]
Abstract
INTRODUCTION The finding of left atria diverticula (LAD) on cardiac computed tomography images obtained from patients with atrial fibrillation (AF) referred for pulmonary vein isolation is not uncommon. Prior studies reporting on LAD do not always provide definitions of LAD resulting in confusion with other anatomical structures such as left atrial accessory appendages (LAAA) and atrial aneurysms. The aim of this review is to identify an accurate definition of LAD and to describe distinctive properties between LAD and other left atrial structures, such as LAAA and aneurysms. Also, the relation between LAD and development of atrial tachyarrhythmias is discussed. METHODS PubMed was searched for studies reporting on atrial aneurysms, left atrial diverticula, left atrial accessory appendages and atrial congenital aneurysms, resulting in 36 papers. RESULTS LAD can be distinguished from LAAA by taking into account embryologic origins of the left atrium and their locations, resulting in the following definitions: (a) LAAA are contractile, trabeculated structures with circumscriptive ostia and narrow necks, originating from the primitive atria, (b) LAD are contractile, sac like structures with either smooth or trabeculated inner surfaces, circumscriptive ostia, narrow necks, and variable morphologies, originating from the embryologic common pulmonary vein, that incorporates into the LA, and (c) atrial aneurysms are non-contractile structures with wide necks and sac like bodies. There are no differences in prevalences of LAD between patients with sinus rhythm and AF. CONCLUSION The pathophysiology of LAD is not yet fully understood. It is unlikely, that LAD are related to the development of atrial tachycardia's and AF by either being a source of ectopic activity or being part of an arrhythmogenic substrate. No differences in LAD prevalences between patients with sinus rhythm and AF have been found. Thus, it is unlikely that LAD could potentially be wolves in sheep's clothing.
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Affiliation(s)
- Danny Veen
- Department of Cardiology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Tobias A Bruning
- Department of Cardiology, Maasstad Hospital, Rotterdam, The Netherlands
| | - Natasja M S de Groot
- Department of Cardiology, Erasmus University Medical Center, Rotterdam, The Netherlands
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Şeker M. The characteristics of left atrial diverticula in normal sinüs rhythm patients. Surg Radiol Anat 2019; 42:377-384. [PMID: 31768699 DOI: 10.1007/s00276-019-02382-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Accepted: 11/18/2019] [Indexed: 11/29/2022]
Abstract
PURPOSE The purpose of this study was to evaluate the prevalence, location, size and morphological characteristics of left atrial diverticula using electrocardiographically gated multi-detector computed tomography in patients with normal sinus rhythm. METHODS Electrocardiographically gated cardiac multi-detector computed tomography was performed in 93 patients with normal sinus rhythm. The prevalence, number, size, morphological characteristics and location of left atrial diverticula were recorded. RESULTS A total of 72 left atrial diverticula were diagnosed in 45 (48.4%) of the 93 patients in this study. Of these 72 diverticula, 66 (91.7%) were cystiform and 6 (8.3%) were tubiform. Anterosuperior wall, left lateral wall and septum were the most common locations of these left atrial diverticula (n = 42, 58.3%; n = 22, 15.3% and n = 7, 9.7%, respectively). CONCLUSION Diverticula are common variations. The discovery of these structures is relatively new and their clinical significance remains unclear. They are generally asymptomatic but although not supported by many studies, in some case reports they are claimed to be associated with arrhythmias and thromboembolism. In addition, it is theoretically reasonable to think that they may cause complications during interventional procedures. Better understanding of these structures has the potential to improve management strategies and reduce potential complications. Therefore, they should be reported during routine cardiac computed tomography.
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Affiliation(s)
- Mehmet Şeker
- Department of Radiology, Medipol Mega Hospital, Faculty of Medicine, Istanbul Medipol University, TEM Avrupa Otoyolu Göztepe Çıkışı No: 1, Bağcılar, 34214, Istanbul, Turkey.
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Hołda MK, Koziej M, Wszołek K, Pawlik W, Krawczyk-Ożóg A, Sorysz D, Łoboda P, Kuźma K, Kuniewicz M, Lelakowski J, Dudek D, Klimek-Piotrowska W. Left atrial accessory appendages, diverticula, and left-sided septal pouch in multi-slice computed tomography. Association with atrial fibrillation and cerebrovascular accidents. Int J Cardiol 2017. [DOI: 10.1016/j.ijcard.2017.06.042] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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15
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Tsao HM, Hu WC, Tsai PH, Lee CL, Wang HH, Chang SL, Chao TF, Chen SA. Functional Remodeling of Both Atria is Associated with Occurrence of Stroke in Patients with Paroxysmal and Persistent Atrial Fibrillation. ACTA CARDIOLOGICA SINICA 2017; 33:50-57. [PMID: 28115807 DOI: 10.6515/acs20160411a] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
BACKGROUND It is critical to recognize high risk patients who are prone to develop stroke in the management of atrial fibrillation (AF). The purpose of this study was to identify the determinants of AF related stroke by assessing the anatomical and functional remodeling of cardiac chambers. METHODS We compared the cardiac structure and function of 28 consecutive patients with paroxysmal and persistent AF-related stroke with 69 patients with AF and 21 controls without stroke using contrast-enhanced 64-slice multi-detector computed tomography during sinus rhythm. RESULTS The volume of left atrium (LA), LA appendage (LAA) and right atrium (RA) were significantly increased across the groups with sinus rhythm (SR), AF and AF-related stroke (p < 0.001 for each, respectively). The emptying fraction and booster-pump function of LA, LAA and RA were decreased across the groups (p < 0.001 for each). In addition, the left ventricular mass index was increased in AF related stroke (p = 0.003). Using multivariate analysis, increased age (p = 0.003), reduced booster-pump function of LA (p = 0.01), LAA (p < 0.001) and RA (p < 0.001) were shown to be independently associated with the occurrence of stroke. CONCLUSIONS The dilatation and contractile dysfunction of both atria are related to the development of stroke in patients with paroxysmal and persistent AF. Our results suggested that the use of substrate-based assessment may help improve risk stratification of stroke in patients with AF.
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Affiliation(s)
- Hsuan-Ming Tsao
- Division of Cardiology, National Yang Ming University Hospital, Yi-Lan
| | - Wei-Chih Hu
- Department of Biomedical Engineering, Chung-Yuan Christian University, Chungli
| | | | | | - Hsueh-Han Wang
- Department of Radiology, National Yang Ming University Hospital
| | - Shih-Lin Chang
- Cardiovascular Research Center, Taipei Veterans General Hospital and National Yang Ming University, Taipei, Taiwan
| | - Tze-Fan Chao
- Cardiovascular Research Center, Taipei Veterans General Hospital and National Yang Ming University, Taipei, Taiwan
| | - Shih-Ann Chen
- Cardiovascular Research Center, Taipei Veterans General Hospital and National Yang Ming University, Taipei, Taiwan
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16
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Terpenning S, Ketai LH, Teague SD, Rissing SM. Prevalence of left atrial abnormalities in atrial fibrillation versus normal sinus patients. Acta Radiol Open 2016; 5:2058460116651899. [PMID: 27358747 PMCID: PMC4904345 DOI: 10.1177/2058460116651899] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2015] [Accepted: 04/22/2016] [Indexed: 11/17/2022] Open
Abstract
Background Atrial fibrillation (AF) may be the cause or sequela of left atrial abnormalities and variants. Purpose To determine the prevalence of left atrial (LA) abnormalities in AF patients compared to normal sinus rhythm (NSR) patients. Material and Methods We retrospectively reviewed 281 cardiac CT examinations from 2010 to 2012, excluding patients with prior pulmonary vein ablation, known coronary artery disease, prior coronary stent placement, or coronary artery bypass grafts. The first group consisted of 159 AF patients undergoing cardiac CT prior to pulmonary vein ablation and the second group consisted of 122 NSR patients evaluated with coronary CT angiography. Demographic data were collected. LA abnormalities were analyzed. Left atrial diameter was measured on an axial view. Results A total of 281 patients were included. The male gender has significantly higher prevalence of AF than female gender, P value <0.001. Patients with AF were significantly older (mean age, 57.4 years; standard deviation [SD], 11.8 years) than NSR patients (mean age, 53.4 years; SD, 13.6 years), P value, 0.01. The left atrial diameter was greater in the AF patients (mean diameter, 4.3 cm; SD, 0.82 cm) versus the NSR patients (3.4 cm; SD, 0.58 cm), P value, <0.0001. LA diverticulum was the most prevalent variant, occurring in 28.4% of the entire patient population followed by LA pouch, occurring in 24%. There was no significant between group differences in the prevalence of these or the remainder of the LA variants. Conclusion AF patients differed significantly from NSR patients in LA size, gender, and mean age. There was no statistical significance between the two groups with regard to the LA morphologic abnormalities other than size.
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Affiliation(s)
| | - Loren H Ketai
- Department of Radiology, University of New Mexico Albuquerque, NM, USA
| | - Shawn D Teague
- Department of Radiology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Stacy M Rissing
- Department of Radiology, Indiana University School of Medicine, Indianapolis, IN, USA
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17
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Chen J, Yang ZG, Xu HY, Shi K, Long QH, Guo YK. Assessments of pulmonary vein and left atrial anatomical variants in atrial fibrillation patients for catheter ablation with cardiac CT. Eur Radiol 2016; 27:660-670. [PMID: 27229337 DOI: 10.1007/s00330-016-4411-6] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Revised: 04/29/2016] [Accepted: 05/13/2016] [Indexed: 02/05/2023]
Abstract
OBJECTIVES To provide a road map of pulmonary vein (PV) and left atrial (LA) variants in patients with atrial fibrillation (AF) before catheter ablation procedure using cardiac CT. METHODS Cardiac CT was performed in 1420 subjects for accurate anatomical information, including 710 patients with AF and 710 matched controls without AF. PV variants, PV ostia and spatial orientation, LA enlargement, and left atrial diverticulum (LAD) were measured, respectively. Differences between these two groups were also respectively compared. Some risk factors for the occurrence of LAD were analyzed. RESULTS In total, PV variants were observed in 202 (28.5 %) patients with AF patients and 206 (29.0 %) controls without AF (p = 0.8153). The ostial sizes of all accessory veins were generally smaller than those of the typical four PVs (p = 0.0153 to 0.3958). There was a significant difference of LA enlargement between the AF and control groups (36.3 % vs. 12.5 %, p < 0.0001), while the prevalence of LAD was similar in these two groups (43.2 % vs. 41.9 %, p = 0.6293). CONCLUSION PV variants are common. Detailed knowledge of PVs and LA variants are helpful for providing anatomical road map to determine ablation strategy. KEY POINTS • PVs variants are helpful for providing anatomical road map to ablation. • PV variants are common. • DSCT could recognize these anatomic features before ablation as a non-invasive imaging.
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Affiliation(s)
- Jing Chen
- Department of Radiology, West China Hospital, Sichuan University, 37# Guo Xue Xiang, Chengdu, Sichuan, 610041, China
| | - Zhi-Gang Yang
- Department of Radiology, West China Hospital, Sichuan University, 37# Guo Xue Xiang, Chengdu, Sichuan, 610041, China.
| | - Hua-Yan Xu
- Department of Radiology, West China Hospital, Sichuan University, 37# Guo Xue Xiang, Chengdu, Sichuan, 610041, China
| | - Ke Shi
- Department of Radiology, West China Hospital, Sichuan University, 37# Guo Xue Xiang, Chengdu, Sichuan, 610041, China
| | - Qi-Hua Long
- Department of Radiology, West China Hospital, Sichuan University, 37# Guo Xue Xiang, Chengdu, Sichuan, 610041, China
| | - Ying-Kun Guo
- Department of Radiology, West China Second University Hospital, Sichuan University, Chengdu, China.
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18
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Seahorse left atrial appendage diverticula mimicking a coronary fistula. Cardiol Young 2015; 25:550-1. [PMID: 25330920 DOI: 10.1017/s104795111400211x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
We report a left atrial appendage diverticulum in close proximity to the left coronary artery, thereby mimicking a fistulous connection between the two structures.
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19
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Owais K, Montealegre-Gallegos M, Matyal R, Pal A, Mahmood F. Left atrial appendage... and another appendage? J Cardiothorac Vasc Anesth 2014; 29:248-9. [PMID: 25483289 DOI: 10.1053/j.jvca.2014.06.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2014] [Indexed: 11/11/2022]
Affiliation(s)
- Khurram Owais
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School Boston, MA
| | - Mario Montealegre-Gallegos
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School Boston, MA; Servicio de Anestesiología Hospital México C.C.S.S., Universidad de Costa Rica, San José, Costa Rica
| | - Robina Matyal
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School Boston, MA
| | - Anam Pal
- Division of Cardiac Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Feroze Mahmood
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School Boston, MA.
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20
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Lei Q, Guo HM, Luo ZC. Surgical treatment of giant left atrial diverticulum in an adult. Ann Thorac Surg 2014; 98:1820-1. [PMID: 25441793 DOI: 10.1016/j.athoracsur.2013.10.110] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2013] [Revised: 10/23/2013] [Accepted: 10/29/2013] [Indexed: 10/24/2022]
Abstract
Giant left atrial diverticulum is a rare congenital abnormality that is most commonly diagnosed in childhood. Here, we report the case of an 18-year-old woman who presented with chest tightness. Contrast-enhanced computed tomography imaging revealed a 12-cm×7-cm left atrial diverticulum. After transesophageal echocardiography was used to exclude left atrial thrombus and mitral regurgitation, an isolated left atrial diverticulum resection was performed. The patient had an uneventful recovery.
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Affiliation(s)
- Qian Lei
- Department of Cardiac Surgery and Anesthesiology, Guangdong Cardiovascular Institute, Guangdong General Hospital, and Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Hui-Ming Guo
- Department of Cardiac Surgery and Anesthesiology, Guangdong Cardiovascular Institute, Guangdong General Hospital, and Guangdong Academy of Medical Sciences, Guangzhou, China.
| | - Zhi-Chao Luo
- Department of Cardiac Surgery and Anesthesiology, Guangdong Cardiovascular Institute, Guangdong General Hospital, and Guangdong Academy of Medical Sciences, Guangzhou, China
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21
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Tan C, Han W, Liu X, Hu X, Liu J, Cui J, Li J. Electrophysiological characteristics of left atrial diverticulum in patients with atrial fibrillation: electrograms, impedance and clinical implications. Int J Cardiol 2014; 176:48-54. [PMID: 25043219 DOI: 10.1016/j.ijcard.2014.06.050] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2014] [Revised: 05/15/2014] [Accepted: 06/24/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND Left atrial diverticulum (LAD) is not rare in patients with atrial fibrillation (AF). Recent reports focused on its morphology however data on its electrophysiological characteristics are lacking. Our study aims to investigate the electrogram and impedance features of LAD. METHODS This study included 24 patients (mean age, 58.5 ± 10.7 years) with LAD undergoing catheter ablation for AF and 24 gender-and-age-matched individuals without LAD as controls. A bipolar LAD electroanatomic map was acquired in sinus rhythm from all study participants. Points were acquired for diverticulum in the LAD group and for corresponding areas in the control group. Electrogram deflections were counted, bipolar voltage and impedance were measured for each point, and average ∆ impedance and highest ∆ impedance were calculated. RESULTS A total of 234 points were collected in the two groups. In the LAD vs. control group, median (Q1, Q3) of electrogram deflections was 6 (5, 7) and 4 (4, 5) (P<0.0001), respectively, voltage was not significantly different (1.58 ± 0.68 mV vs. 1.28 ± 0.65 mV, P=0.10), and average ∆ impedance was significantly higher in the LAD group (19.5 ± 9.0 Ω vs 3.9 ± 1.7 Ω, P<0.0001). A cut-off value of 9.5 Ω for ∆ impedance predicted LAD with sensitivity, specificity, and positive and negative predictive values of 83.5%, 92.8%, 92.1% and 84.9%, respectively. CONCLUSIONS Electrogram was more fractionated and impedance was higher at LAD than in corresponding areas without LAD, which might help to differentiate LAD during catheter ablation for AF.
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Affiliation(s)
- Chen Tan
- Department of Cardiology, Beijing Military Region General Hospital of PLA, Beijing, China.
| | - Wei Han
- Department of Radiology, Beijing Military Region General Hospital of PLA, Beijing, China
| | - Xingpeng Liu
- Department of Cardiology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Xuehong Hu
- Department of Cardiology, Beijing Military Region General Hospital of PLA, Beijing, China
| | - Jianguo Liu
- Department of Cardiology, Beijing Military Region General Hospital of PLA, Beijing, China
| | - Junyu Cui
- Department of Cardiology, Beijing Military Region General Hospital of PLA, Beijing, China
| | - Junxia Li
- Department of Cardiology, Beijing Military Region General Hospital of PLA, Beijing, China
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22
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Left atrial diverticulum. Herz 2013; 38:943-4. [DOI: 10.1007/s00059-013-3781-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2013] [Accepted: 02/12/2013] [Indexed: 10/27/2022]
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23
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Genç B, Solak A, Kantarci M, Bayraktutan U, Ogul H, Yüceler Z, Oztürk A, Kizrak Y. Anatomical features and clinical importance of left atrial diverticula: MDCT findings. Clin Anat 2013; 27:738-47. [PMID: 24214737 DOI: 10.1002/ca.22320] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2013] [Revised: 08/07/2013] [Accepted: 08/15/2013] [Indexed: 11/09/2022]
Abstract
To assess the anatomical features and clinical importance of left atrial diverticula and atrial accessory appendages in patients undergoing cardiac computed tomography with multidetector computed tomography. A total of 1305 consecutive patients (385 female, 29.5%; 920 male, 70.5%) were assessed using electrocardiogram-gated computed tomography between May 2010 and June 2013. The anatomical features and the prevalences of left atrial diverticula and left atrial accessory appendages were retrospectively assessed by four radiologists. The relationships between the prevalence and size of the diverticula and the age and gender of the patients were assessed. Among the 1305 patients, 610 (46.7%) exhibited 708 left atrial diverticula, and 62 (4.8%) exhibited left atrial accessory appendages. The most common locations of the left atrial diverticula were the right anterior superior wall (n = 328, 46.3%) and the lateral superior wall (n = 96, 13.5%). In addition to classical cystic and tubular diverticula, 49 (3.7%) of the patients exhibited mixed (cystic-tubular), conical, or hook-shaped diverticula and diverticular forms containing mural calcifications. There was no significant relationship between the prevalence of diverticula and the age and gender of the patients (P > 0.05). In addition to tubular and cystic diverticula, the left atrial wall can host different diverticular forms (such as mixed, conical, calcific, and hook shaped). It could be beneficial to assess the left atrium using MDCT to determine the source of emboli in cryptogenic embolism and to reduce complications associated with interventional procedures performed for left atrial arrhythmias.
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Affiliation(s)
- Berhan Genç
- Şifa University, School of Medicine, Department of Radiology, İzmir, Turkey
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24
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Circulation: Cardiovascular Imaging
Editors’ Picks. Circ Cardiovasc Imaging 2013. [DOI: 10.1161/circimaging.113.001335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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25
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DE PONTI ROBERTO, LUMIA DOMENICO, MARAZZI RAFFAELLA, MAMELI STEFANO, DONI LORENZOA, DE VENUTO GIOVANNI, FUGAZZOLA CARLO, SALERNO-URIARTE JORGEA. Left Atrial Diverticula in Patients Undergoing Atrial Fibrillation Ablation: Morphologic Analysis and Clinical Impact. J Cardiovasc Electrophysiol 2013; 24:1232-1239. [DOI: 10.1111/jce.12213] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
Affiliation(s)
| | - DOMENICO LUMIA
- Department of Radiology; Ospedale di Circolo e Fondazione Macchi-University of Insubria; Varese Italy
| | | | | | | | - GIOVANNI DE VENUTO
- Department of Radiology; Ospedale di Circolo e Fondazione Macchi-University of Insubria; Varese Italy
| | - CARLO FUGAZZOLA
- Department of Radiology; Ospedale di Circolo e Fondazione Macchi-University of Insubria; Varese Italy
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Ko JY, Kim YD, Hong YJ, Lee HJ, Hur J, Choi BW, Heo JH, Kim YJ. Lack of association between stroke and left atrial out-pouching structures: results of a case-control study. PLoS One 2013; 8:e76617. [PMID: 24116128 PMCID: PMC3792154 DOI: 10.1371/journal.pone.0076617] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2013] [Accepted: 08/27/2013] [Indexed: 11/19/2022] Open
Abstract
Background and Purpose Clinical significance of out-pouching structures of the left atrium (LA) as potential embolic sources remains unclear. We sought to evaluate the association between stroke and LA out-pouching structures. Methods A case-control study was conducted to assess the prevalence of LA out-pouching structures in subjects with and without stroke. Case subjects were 270 stroke patients who had undergone cardiac CT. Control subjects were 270 age- and sex-matched patients without a history of stroke and who had undergone cardiac CT. Presence of LA out-pouching structures was determined by ECG-gated cardiac CT. The location of out-pouching structures was categorized as near Bachmann bundle, anterior, inferoseptal, inferior, and lateral. The prevalence, number and location of out-pouching structures and clinical characteristics were compared between the two groups. Results One hundred sixty eight out-pouching structures were identified in 139 stroke patients (51%), while a total of 169 out-pouching structures were found in 155 control patients (57%) (p=0.1949). The prevalence of LA out-pouching structures with different locations was not significantly different between the stroke group and control group. In the stroke group, the prevalence of out-pouching structures was not significantly different by subtypes of ischemic stroke and the prevalence of LA out-pouching structures was not different between patients with atrial fibrillation (AF) and without AF. Conclusion The left atrial out-pouching structures are commonly seen in a population with and without stroke with similar prevalence. Our study suggests that LA out-pouching structures are not significant risk factors of stroke.
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Affiliation(s)
- Ji Young Ko
- Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Young Dae Kim
- Department of Neurology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Yoo Jin Hong
- Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Hye-Jeong Lee
- Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Jin Hur
- Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Byoung Wook Choi
- Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
- Division of Cardiovascular Radiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Ji Hoe Heo
- Department of Neurology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Young Jin Kim
- Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
- * E-mail:
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Patel S, French A, Mathias H, Lyen S, Hamilton M, Manghat N. Presence of left atrial diverticula, accessory appendages, and normal variant pulmonary venous anatomy diagnosed using MDCT and adverse outcomes following radiofrequency catheter ablation therapy in patients with drug-refractory atrial fibrillation: An exploratory study. Clin Radiol 2013; 68:762-9. [DOI: 10.1016/j.crad.2013.02.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2012] [Revised: 02/07/2013] [Accepted: 02/19/2013] [Indexed: 10/27/2022]
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Hur J, Pak HN, Kim YJ, Lee HJ, Chang HJ, Hong YJ, Choi BW. Dual-enhancement cardiac computed tomography for assessing left atrial thrombus and pulmonary veins before radiofrequency catheter ablation for atrial fibrillation. Am J Cardiol 2013; 112:238-44. [PMID: 23582630 DOI: 10.1016/j.amjcard.2013.03.018] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2013] [Revised: 03/14/2013] [Accepted: 03/14/2013] [Indexed: 11/30/2022]
Abstract
Noninvasive imaging that provides anatomic information while excluding intracardiac thrombus would be of significant clinical value for patients referred for catheter ablation of atrial fibrillation (AF). This study assessed the diagnostic performance of a dual-enhancement single-phase cardiac computed tomography (CT) protocol for thrombus and circulatory stasis detection in AF patients before catheter ablation. We studied 101 consecutive symptomatic AF patients (71 men and 30 women; mean age, 61.8 years) who were scheduled to have catheter ablation. All patients had undergone pre-AF ablation CT imaging and transesophageal echocardiography on the same day. CT was performed with prospective electrocardiographic gating, and scanning began 180 seconds after the test bolus. Mean left atrial appendage (LAA)/ascending aorta Hounsfield unit (HU) ratios were measured on CT images. Among the 101 patients, 9 thrombi and 18 spontaneous echo contrasts were detected by transesophageal echocardiography. The overall sensitivity, specificity, positive predictive value, and negative predictive value of CT for the detection of thrombi in the LAA were 89%, 100%, 100%, and 99%, respectively. The mean LAA/ascending aorta HU ratios were significantly different between thrombus and circulatory stasis (0.17 vs 0.33, p = 0.002). Dual-enhancement single-scan cardiac CT is a sensitive modality for detecting and differentiating LAA thrombus and circulatory stasis.
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Affiliation(s)
- Jin Hur
- Department of Radiology, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, South Korea
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