Left Atrial Geometry Improves Risk Prediction of Thromboembolic Events in Patients With Atrial Fibrillation

Abstract

LA sphericity is associated with prior TE in AF patients and improves the performance of the CHAD and CHA2 D-VASc scores alone.

Impact of left atrial volume, sphericity, and fibrosis on the outcome of catheter ablation for atrial fibrillation

“…It is thought that the remodelling process involves a progressive change in atrial morphology that evolves from discoid‐shaped to sphere‐shaped, thereby progressively increasing the sphericity value. Previous work by our group has shown that a high LA sphericity value is associated with a higher risk for AF recurrence after ablation and improves the performance of the CHADS‐VASc score in stroke prediction …”

Risk of Stroke and Recurrence After AF Ablation in Patients With an Initial Event‐Free Period of 12 Months

“…However, it is also possible that patients selected for ablation have unidentifiable confounding factors of better vitality that make them good candidates for ablation but also reduce their overall stroke risk. Furthermore, other factors like the structure and geometry of the left atrium and the anatomy of the left atrial appendage could contribute to a patient's risk of stroke. In these studies, care providers are not blinded to any data and are having individual discussions with patients who have their own values.…”

“…In addition to other important risk factors influencing the individual patient's risk for thromboembolism like left atrial appendage anatomy, a successful ablation of AF would seem to be an important requirement for any consideration of discontinuing OAC . However, the definition of a successful ablation is difficult.…”

“…12,13 Asymptomatic recurrence of AF is an important reason why oral anticoagulation (OAC) is not discontinued postablation in higher risk patients. 1 In addition to other important risk factors influencing the individual patient's risk for thromboembolism like left atrial appendage anatomy, 14,15 a successful ablation of AF would seem to be an important requirement for any consideration of discontinuing OAC. 16,17 However, the definition of a successful ablation is difficult.…”

Darned If You Do…Darned If You Don't

“…In this issue of the Journal , Bisbal et al . put forward and quantify a new imaging parameter, left atrial sphericity (LASP), a measurement of left atrial remodeling, and describe its additive predictive value in thromboembolic event (TE) risk estimation . Their hypothesis has a reasonable basis because the left atrium (LA) is the source of cardiac thrombus formation, and emboli from the LA are responsible for the vast majority of transient ischemic attacks and strokes in patients with AF .…”