Structural Remodeling of the Left Atrial Appendage in Patients with Chronic Non-Valvular Atrial Fibrillation

Shirani, Jamshid; Alaeddini, Jamshid

doi:10.1016/s1054-8807(00)00030-2

Cited by 168 publications

(32 citation statements)

References 21 publications

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“…Shirani and Alaeddini [18]reported that LAA remodeling (dilation, stretching, and reduction in pectinate muscle volume, as well as endocardial thickening with fibrous and elastic tissue) occurs frequently in the setting of chronic AF and might contribute to the increased risk of thrombus formation and systemic embolism. We think that LAA remodeling causes endocardial abnormalities, and that thrombus formation occurs because of blood flow stasis (spontaneous echogenic contrast) and abnormal coagulation (increased serum fibrinogen) in the trabecular regions of the LAA in patients with NVAF.…”

Section: Discussionmentioning

confidence: 99%

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Is the Site of Thrombus Formation in the Left Atrial Appendage Associated with the Risk of Cerebral Embolism?

Yamaji¹,

Fujimoto

Yutani

et al. 2002

Cardiology

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Atrial fibrillation (AF) is a risk factor for cerebral embolism, with the left atrial appendage (LAA) being considered as the source of emboli. However, the relationship between the histologic properties of LAA thrombi and the occurrence of cerebral embolism is not known. Seventy-six hearts from patients who died within 1 month after cerebral embolism were studied at autopsy. Patients were grouped according to the presence of AF and the presence of valvular disease (VD). We determined whether the LAA thrombi adhered to the trabecular region or the remainder of the LAA. LAA thrombi were grouped into three stages: a fresh stage in which thrombi consisted of fibrin and platelets, an organizing stage in which angiogenesis was observed in the thrombi, and an organized stage in which endothelial cells covered the surface of the thrombi. The AF+/VD– group included 19 patients (25.0%), the AF+/VD+ group 8 (10.5%), the AF–/ VD– group 37 (48.7%), and the AF–/VD+ group included 12 patients (15.8%). LAA thrombi were observed in 15 patients (78.9%) in the AF+/VD– group, and all of the thrombi adhered to the trabecular region. Thrombi in the fresh and the organizing stages were observed in 10 patients (66.7%). Patients in the AF+/VD– group accounted for about 25% of the cases of cerebral embolism. All of these thrombi were attached to the trabecular region, and about 70% of them could represent an embolic source.

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Section: Discussionmentioning

confidence: 99%

“…Shirani and Alaeddini [18]reported that patients with AF had significantly greater LAA volumes and a larger LAA luminal surface area compared to those without AF. Furthermore, in most patients with chronic AF, there is significant endocardial thickening of the LAA with fibrous and elastic tissue (endocardial fibroelastosis).…”

Section: Discussionmentioning

confidence: 99%

Is the Site of Thrombus Formation in the Left Atrial Appendage Associated with the Risk of Cerebral Embolism?

Yamaji¹,

Fujimoto

Yutani

et al. 2002

Cardiology

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“…Dimensional changes need to interpreted with caution, as AF itself is associated with larger atrial and LAA dimensions. 30, 99 …”

Section: Stroke Mechanisms In Atrial Fibrillationmentioning

confidence: 99%

Left Atrial Appendage Exclusion for Atrial Fibrillation

et al. 2014

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SYNOPSIS Percutaneous left atrial appendage (LAA) closure is increasingly being used as a treatment strategy to prevent stroke in patients with atrial fibrillation (AF) who have contraindications to anticoagulants. A number of approaches and devices have been developed in the last few years, each with their own unique set of advantages and disadvantages. We review the published studies on surgical and percutaneous approaches to LAA closure; focusing on stroke mechanisms in AF, LAA structure and function relevant to stroke prevention, practical differences in procedural approach, and clinical considerations surrounding management.

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“…Structural remodeling of the left atrial appendage to include the pectinate muscles and multiple lobes of the lumen occurs in patients with permanent atrial fibrillation [2]. Morphologic studies have shown larger volumes and luminal surface areas when compared to patients without atrial fibrillation; however, both the absolute and relative surface areas of the pectinate muscles are reduced.…”

mentioning

confidence: 99%

“…Morphologic studies have shown larger volumes and luminal surface areas when compared to patients without atrial fibrillation; however, both the absolute and relative surface areas of the pectinate muscles are reduced. In addition, there is significant endocardial thickening with fibrous and elastic tissue (endocardial fibroelastosis) [2]. Endothelial progenitor cells from patients with permanent atrial fibrillation have an intrinsic tendency to differentiate into cells expressing cardio (myocyte) markers atrial natriuretic polypeptide and myocyte enhances factor-2.…”

mentioning

confidence: 99%

Thrombogenesis in atrial fibrillation contributing mechanisms and natural history

Becker

2009

J Thromb Thrombolysis

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Atrial fibrillation and its closely related counterpart, atrial flutter are not only common arrhythmias, but also contribute directly to unparalleled morbidity, mortality, and health care expenditures worldwide by virtue of their relation with cardioembolic stroke. While an existing thrombotic substrate is widely recognized, less well described are the natural history of thrombus initiation and development, specifically the sequence of events and contribution of both local (tissue level) and circulating factors, and the participation of thrombus in left atrial/left atrial appendage remodeling.

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Structural Remodeling of the Left Atrial Appendage in Patients with Chronic Non-Valvular Atrial Fibrillation

Cited by 168 publications

References 21 publications

Is the Site of Thrombus Formation in the Left Atrial Appendage Associated with the Risk of Cerebral Embolism?

Is the Site of Thrombus Formation in the Left Atrial Appendage Associated with the Risk of Cerebral Embolism?

Left Atrial Appendage Exclusion for Atrial Fibrillation

Thrombogenesis in atrial fibrillation contributing mechanisms and natural history

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