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Europace Advance Access originally published online on October 17, 2007
Europace 2007 9(12):1134-1140; doi:10.1093/europace/eum227
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Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2007. For permissions please email: journals.permissions@oxfordjournals.org

ATRIAL FIBRILLATION

Dynamic multidimensional imaging of the human left atrial appendage

Joan M. Lacomis1, Orly Goitein1, Christopher Deible1, Pauline L. Moran1, Giuseppe Mamone1, Shobhit Madan1 and David Schwartzman2,*

1 Department of Radiology, University of Pittsburgh, Pittsburgh, PA, USA; 2 Cardiovascular Institute, University of Pittsburgh, UPMC Presbyterian, B535, Pittsburgh, PA 15213-2582, USA

Aims: The human left atrial appendage (LAA) is a region of increasing interest as a target for intervention. We sought to improve insight into the anatomy of this region using computed tomography (CT).

Methods and results: Multidimensional cardiac reconstruction (whole heart and isolated left atrium) from CT images was performed in each of three groups: (i) patients without atrial fibrillation (AF, n =10); (ii) patients with intermittent (paroxysmal) AF (n = 25); (iii) patients with continuous (persistent) AF (n = 10). Indices included LAA morphology, anatomical relationships, dimensions, angulation, and motility. There was substantial interindividual variation in each index. LAA morphologic differences were associated with variations in anatomical relationships. LAA dimensions in AF patients exceeded those in patients without AF, but angulation and motility were similar. The LAA could be subdivided into proximal and distal portions, each of which had distinct morphology and anatomical relationships. Dimensions in men tended to exceed those in women.

Conclusion: Regardless of AF history, there is broad variation in LAA morphology, anatomical relationships, dimensions, angulation, and motility. These observations may have importance for the development of technologies for therapy delivery in this region.

Key Words: Atrial appendage, Atrial fibrillation, Computed tomography

* Corresponding author. Tel: +1 412 647 2762; fax: +1 412 647 7979. E-mail address: schwartzmand{at}upmc.edu

Manuscript submitted 26 July 2007. Accepted after revision 12 September 2007.


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