Right Atrial Appendage Function in Patients with Chronic Nonvalvular Atrial Fibrillation.

Abstract

SUMMARYTo assess right atrial appendage (RAA) flow and its possible relationship to left atrial appendage (LAA) flow in chronic nonvalvular atrial fibrillation (AF), transesophageal echocardiography (TEE) was performed in 26 patients with chronic nonvalvular AF (group I). For the purpose of comparison, an additional group of 27 patients with chronic valvular AF due to mitral stenosis (group II) was analyzed. The clinically estimated duration of AF in group I was significantly longer than that of group II (8.7 ± 3.4 versus 2.7 ± 1.1 years). Although right atrial size and RAA maximal area were larger in group I than those in group II, left atrial size was larger in group II than that in group I. Group II had larger LAA maximal areas than group I, but this difference did not reach statistical significance. The two groups were not different with respect to the RAA or LAA emptying velocities. Significant correlations were observed between echocardiographic parameters of the two atria in patients with nonvalvular AF (r range, 0.4 to 0.7). In contrast, in patients with valvular AF, no correlation was observed between the echocardiographic parameters of the two atria (appendage emptying velocity, r = 0.38, p = 0.051; atrial size, r = − 0.03, p = 0.89; maximal appendage area, r = 0.07, p = 0.75, respectively). There were no significant differences in the presence of right and left atrial spontaneous echo contrast and thrombus between the groups. All of the right and left atrial thrombi were confined to their respective appendages and were found in the atria with spentaneous echo contrast. Both RAA and LAA thrombi were present in one patient. In conclusion, our findings suggest that AF could affect both atria equally in nonvalvular AF, in contrast to valvular AF. Therefore, the assessment of RAA function as well as LAA may be important in patients with chronic nonvalvular AF. (Jpn Heart J 2000; 41: 451-462)

The right ventricle in patients with chronic heart failure and atrial fibrillation

“…Relationship between the dimensions and function of the right atrium and occurrence of AF is properly documented [35,36]. Enlargement and remodeling of both atria predispose to development of AF.…”

“…Studies using stress echocardiography showed the prognostic values of the right atrium area to maintain sinus rhythm after AF ablation [35]. However, on the basis of existing evidence, area of the right atrium can be used to assess prognosis only in patients with non-valvular AF [36].…”

Procoagulant State in Heart Failure With Preserved Left Ventricular Ejection Fraction

“…Our study was not designed to address a possible mechanistic explanation of such changes; central hemodynamic derangements in patients with heart failure represent a complex interplay of several factors, such as impaired ventricular pump function, atrial contractility and the functional integrity of the mitral apparatus, among others. [26][27][28] Moreover, patients at high risk of thrombus formation because of cardiac hemodynamic derangements (ie, patients with severely impaired LVEF or atrial fibrillation) have to be anticoagulated [29][30][31][32] and were thus excluded from our study (anticoagulation therapy was an exclusion criterion in order to avoid obvious confounding interactions between anticoagulation therapy and hemostatic derangements). In our study, transthoracic echocardiographic imaging did not detect a thrombus in any of the included patients.…”

Contemporary echocardiographic assessment of atrial appendages in non-valvular atrial fibrillation

“…It is no wonder that thrombi can form also in the RA, and especially in its appendage (Fig. 6) [55,56]. There are serious reasons to assume that dysfunction of RAA in AF may cause thrombi formation in the right heart.…”

“…In various studies, the incidence of SEC and thrombi in the RA and its appendage in patients with AF ranged between 1-7.5% and 10-57% [56][57][58][59]. Although systemic thromboembolism risk is mostly studied, pulmonary embolism is also possible in patients with AF.…”