Left atrial appendage size in patients with atrial fibrillation in Japan and the United States
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ORIGINAL ARTICLE
Left atrial appendage size in patients with atrial fibrillation in Japan and the United States Sachiyo Ono1 · Shunsuke Kubo1 · Takeshi Maruo1 · Saibal Kar2 · Kazushige Kadota1 Received: 22 April 2020 / Accepted: 28 August 2020 © Springer Japan KK, part of Springer Nature 2020
Abstract Left atrial appendage (LAA) evaluation is important to select the optimal LAA closure device for patients with atrial fibrillation (AF). The LAA characteristics of Japanese patients remain uninvestigated. We compared the LAA size and morphology between 212 Japanese AF patients before catheter ablation and 119 AF patients undergoing LAA closure in the United States (US). We measured the LAA ostial dimension and depth by transesophageal echocardiography in all patients and determined the LAA morphology types of Japanese patients by multidetector cardiac computed tomography and those of US patients by LAA angiography. The maximum LAA ostial dimension was significantly larger in Japanese patients than in US patients (22.6 ± 4.1 mm vs. 21.5 ± 3.5 mm, P = 0.02). Also, Japanese patients had larger maximum dimension and depth corrected by body surface area than US patients in both paroxysmal and nonparoxysmal AF groups. The angle showing the maximum dimension was 0° or 135° in approximately 75% of patients in both groups. The common LAA morphology types were “cauliflower” and “chicken wing” in Japanese patients and “cactus” and “windsock” in US patients. In this study, Japanese patients had a larger LAA size than US patients. Because the maximum LAA dimension was obtained at the same angles, the LAA measurement method for US patients can be applicable to Japanese patients. Keywords Atrial fibrillation · Left atrial appendage · Left atrial appendage closure · Multidetector cardiac computed tomography · Transesophageal echocardiography
Introduction Nonvalvular atrial fibrillation (AF) increases the risk of stroke by nearly fivefold [1]. Oral anticoagulants (OAC) effectively reduce the risk of ischemic stroke in AF patients [2]. Despite OAC therapy, however, stroke can occur. Also, some patients cannot continue OAC therapy because of bleeding events. Transcatheter occlusion of the left atrial appendage (LAA) has emerged as an alternative mechanical approach to reduce cardioembolic risk in AF patients [3]. The rationale for LAA closure (LAAC) is based on a strong evidence that more than 90% of thrombi during nonvalvular AF originate in the LAA [4]. LAAC using a WATCHMAN device (Boston Scientific, Marlborough, MA, USA) * Shunsuke Kubo daba‑[email protected] 1
Department of Cardiology, Kurashiki Central Hospital, 1–1–1 Miwa, Kurashiki 710‑0052, Japan
Cedars‑Sinai Medical Center, Heart Institute, Los Angeles, CA, USA
2
for nonvalvular AF patients who cannot tolerate long-term OAC therapy was approved by the Food and Drug Administration in 2015. The LAA morphology varies by individual, and therefore size measurement and morphology evaluation of the LAA before device implantation are necessary to select the optim
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