Skip to main content
Log in

Analysis of the left atrial appendage morphology by intracardiac echocardiography in patients with atrial fibrillation

  • Published:
Journal of Interventional Cardiac Electrophysiology Aims and scope Submit manuscript

Abstract

Background

Detailed information regarding the structure and dimensions of the left atrial appendage (LAA) is required to guide implantation of LAA occlusion devices in patients with atrial fibrillation (AF). Currently, this procedure is guided by transesophageal echocardiography (TEE).

Objective

The objective of this study was to evaluate the accuracy of intracardiac echocardiography (ICE) in assessing LAA dimensions.

Methods

The LAA anatomy was analyzed in 21 consecutive patients (age 62 ± 9 years, five women, six paroxysmal AF) who underwent catheter ablation for AF. All patients had pre-procedural scans (computed tomography (CT), N = 9; magnetic resonance imaging (MRI), N = 12) of the left atrium (LA). An 8-Fr phased-array ICE catheter was used to obtain images of the LAA. The LAA was visualized with the ICE probe placed sequentially in the right atrium (RA, N = 21 patients), in the coronary sinus (CS, N = 20 patients), and in the LA (N = 21 patients).

Results

ICE imaging from the LA showed a LAA ostium diameter of 24 ± 4 mm and a LAA depth of 32 ± 4 mm. There was strong correlation between the measurements by ICE and the values obtained by CT and MRI. The LAA was visualized in all cases from all locations (RA, CS, and LA), but complete visualization of the LAA could not be obtained from the RA and the CS in a significant number of cases, preventing accurate measurements.

Conclusions

Imaging of LAA using an ICE probe positioned in the LA results in accurate measurements of LAA dimensions. This imaging modality could potentially be used during implantation of LAA occlusion devices as an alternative to TEE.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6

Similar content being viewed by others

Abbreviations

LAA:

Left atrial appendage

AF:

Atrial fibrillation

TEE:

Transesophageal echocardiography

ICE:

Intracardiac echocardiography

LA:

Left atrium

RA:

Right atrium

CS:

Coronary sinus

References

  1. Holmes, D. R., Reddy, V. Y., Turi, Z. G., Doshi, S. K., Sievert, H., Buchbinder, M., et al. (2009). Percutaneous closure of the left atrial appendage versus warfarin therapy for prevention of stroke in patients with atrial fibrillation: A randomised non-inferiority trial. Lancet, 374, 534–542.

    Article  PubMed  CAS  Google Scholar 

  2. Fountain, R., Holmes, D. R., Jr., Hodgson, P. K., Chandrasekaran, K., Van Tassel, R., & Sick, P. (2006). Potential applicability and utilization of left atrial appendage occlusion devices in patients with atrial fibrillation. American Heart Journal, 152, 720–723.

    Article  PubMed  Google Scholar 

  3. Sievert, H., Lesh, M. D., Trepels, T., Omran, H., Bartorelli, A., Della Bella, P., et al. (2002). Percutaneous left atrial appendage transcatheter occlusion to prevent stroke in high-risk patients with atrial fibrillation: Early clinical experience. Circulation, 105, 1887–1889.

    Article  PubMed  Google Scholar 

  4. Sick, P. B., Schuler, G., Hauptmann, K. E., Grube, E., Yakubov, S., Turi, Z. G., et al. (2007). Initial worldwide experience with the Watchman left atrial appendage system for stroke prevention in atrial fibrillation. Journal of the American College of Cardiology, 49, 1490–1495.

    Article  PubMed  Google Scholar 

  5. Jorgensen, J., Palmer, S., Kalogeropoulos, A., Arita, T., Block, P., Martin, R., et al. (2007). Implantation of left atrial appendage occlusion devices and complex appendage anatomy: The importance of transesophageal echocardiography. Echocardiography, 24, 159–161.

    Article  PubMed  Google Scholar 

  6. Ho, I. C., Neuzil, P., Mraz, T., Beldova, Z., Gross, D., Formanek, P., et al. (2007). Use of intracardiac echocardiography to guide implantation of a left atrial appendage occlusion device (PLAATO). Heart Rhythm, 4, 567–571.

    Article  PubMed  Google Scholar 

  7. Heist, E. K., Refaat, M., Danik, S. B., Holmvang, G., Ruskin, J. N., & Mansour, M. (2006). Analysis of the left atrial appendage by magnetic resonance angiography in patients with atrial fibrillation. Heart Rhythm, 3, 1313–1318.

    Article  PubMed  Google Scholar 

  8. Bland, J. M., & Altman, D. G. (1986). Statistical methods for assessing agreement between two methods of clinical measurement. Lancet, 1, 307–310.

    Article  PubMed  CAS  Google Scholar 

  9. Saksena, S., Sra, J., Jordaens, L., Kusumoto, F., Knight, B., Natale, A., et al. (2010). A prospective comparison of cardiac imaging using intracardiac echocardiography with transesophageal echocardiography in patients with atrial fibrillation: The intracardiac echocardiography guided cardioversion helps interventional procedures study. Circ Arrhythm Electrophysiol, 3, 571–577.

    Article  PubMed  Google Scholar 

  10. Nakajima, H., Seo, Y., Ishizu, T., Yamamoto, M., Machino, T., Harimura, Y., et al. (2010). Analysis of the left atrial appendage by three-dimensional transesophageal echocardiography. The American Journal of Cardiology, 106, 885–892.

    Article  PubMed  Google Scholar 

  11. Morton, J. B., Sanders, P., Sparks, P. B., Morgan, J., & Kalman, J. M. (2002). Usefulness of phased-array intracardiac echocardiography for the assessment of left atrial mechanical “stunning” in atrial flutter and comparison with multiplane transesophageal echocardiography. The American Journal of Cardiology, 90, 741–746.

    Article  PubMed  Google Scholar 

Download references

Conflicts of interest

Dr. Dan Blendea, Dr. Stephan Danik, and Dr. Conor Barrett have no potential conflicts of interest. Dr. E. Kevin Heist has served as a consultant and received research grants from St. Jude Medical and Boston Scientific. Dr. Jeremy N. Ruskin has served as consultant for Medtronic and Biosense Webster and received honorarium for faculty participation in Fellows program from Boston Scientific and St. Jude Medical. Dr. Moussa Mansour has served as a consultant for Biosense Webster.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Moussa Mansour.

Additional information

This work was partially supported by the Deane Institute for Integrative Research in Atrial Fibrillation and Stroke

Rights and permissions

Reprints and permissions

About this article

Cite this article

Blendea, D., Heist, E.K., Danik, S.B. et al. Analysis of the left atrial appendage morphology by intracardiac echocardiography in patients with atrial fibrillation. J Interv Card Electrophysiol 31, 191–196 (2011). https://doi.org/10.1007/s10840-011-9559-z

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10840-011-9559-z

Keywords

Navigation