Abstract
Background
Successful implantation of the WATCHMAN device requires an accurate understanding of left atrial appendage (LAA) anatomy and orifice dimensions. Racial differences are observed in LAA size when comparing Asians with non-Asians.
Methods
A total of 170 patients (123 male, 67.4 ± 9.2 years) with paroxysmal or persistent atrial fibrillation (AF) underwent transesophageal echocardiography before catheter ablation or cardioversion (September 2018 to September 2019). As per the recommendations of the WATCHMAN device, the maximal LAA ostial diameters were measured at multiplane angles of 0°, 45°, 90°, and 135°.
Results
The majority of patients (121/170, 71%) had an LAA orifice size within 17–25 mm. Fifteen (8.8%) patients had undersized (< 17 mm) and eight (0.5%) had oversized (> 31 mm) LAA. One patient in this population had no LAA. LAA size was significantly larger in patients with persistent AF than in those with paroxysmal AF (23.3 ± 4.2 mm vs. 20.0 ± 3.0 mm, p < 0.001) and in male patients than in female patients (22.4 ± 4.2 vs. 20.9 ± 3.7 mm, p = 0.03). LAA orifice dimension was significantly correlated with CHADS2 score, the left atrial volume (LAV), E/e′, and the left ventricular ejection fraction. Persistent AF, body mass index, and LAV were independently associated with LAA orifice dimension in multivariate analysis.
Conclusion
This study demonstrated the distribution of LAA orifice dimension in the Japanese AF patients. This finding should be used as a reference to understand the racial characteristics of LAA size for the WATCHMAN procedure.
Similar content being viewed by others
References
Reddy VY, Doshi SK, Sievert H, et al. Percutaneous left atrial appendage closure for stroke prophylaxis in patients with atrial fibrillation 2.3-year follow-up of the PROTECT AF (Watchman left atrial appendage system for embolic protection in patients with atrial fibrillation) trial. Circulation 2013;127:720–29.
Holmes DR Jr, Kar S, Price MJ, et al. Prospective randomized evaluation of the watchman left atrial appendage closure device in patients with atrial fibrillation versus long-term warfarin therapy: the PREVAIL trial. J Am Coll Cardiol. 2014;64:1–12.
Phillips KP, Santoso T, Sanders P, et al. Left atrial appendage closure with WATCHMAN in Asian patients: 2year outcomes from the WASP registry. IJC Heart Vasc. 2019;23: 100358. https://doi.org/10.1016/j.ijcha.
Calkins H, Hindricks G, Cappato R, et al. 2017 HRS/EHRA/ECAS/APHRS/SOLAECE expert consensus statement on catheter and surgical ablation of atrial fibrillation. Europace. 2018;20:e1–160.
Chen YY, Zhang YH, Chen X, et al. Left atrial appendage orifice diameter measured with trans-esophageal echocardiography is independently related with peri-device leakage after Watchman device implantation. Int J Cardiovasc Imaging. 2019;35:1831–9.
Aonuma K, Yamasaki H, Nakamura M, et al. Percutaneous WATCHMAN left atrial appendage closure for Japanese patients with nonvalvular atrial fibrillation at increased risk of thromboembolism. -First results from the SALUTE trial-. Circ J 2018;82:2946–53.
Saw J, Fahmy P, Spencer R, et al. Comparong measuremetns of ct Angiography, TEE, and fluoroscopy of the left atrial appendage for percutaneous closure. J Cardiovasc Electrophysiol. 2016;27:414–22.
Bo Xu, Betancor J, Sato K, et al. Computed tomography measurement of the left atrial appendage for optimal sizing of the Watchman device. J Cardiovascular Computed Tomography. 2018;12:50–5.
Cohen GI, White M, Sochowski RA, et al. Reference value for normal transesophageal measurements. J Am Soc Echocardiogr. 1995;8:221–30.
Walker DT, Humphries JA, Phillips KP. Anatomical analysis of the left atrial appendage using segmented, three-dimensional cardiac CT: a comparison of patients with paroxysmal and persistent forms of atrial fibrillation. J Interv Card Electrophysiol. 2012;34:173–9.
Huang G, Parikh PB, Malhotra A, et al. Relation of body mass index and gender to left atrial size and atrial fibrillation. Am J Cardiol. 2017;120:218–22.
Cemri M, Timurkaynak T, Ozdemir M, et al. Effects of left ventricular systolic dysfunction on left atrial appendage and left atrial functions in patients with chronic nonvalvular atrial fibrillation. Acta cardiol. 2002;57:101–5.
Bakalli A, Kamberi L, Pllana E, et al. The influence of left ventricular diameter on left atrial appendage size and thrombus formation in patients with dilated cardiomyopathy. Turk Kardiyol Dern Ars. 2010;38:90–4.
Funding
This research received no grants from any funding agencies in the public, commercial, or not-for-sectors.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
Miho Miyoshi, Nozomi Watanabe, Tomoko Fukuda, Shun Nishino, Toshiyuki Kimura, Makoto Furugen, Keiichi Ashikaga, Naohiko Takahashi and Yoshisato Shibata declare that they have no conflicts of interest.
Human rights statement
All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1964 and later versions.
Informed consent
Informed consent was obtained from all patients for being included in the study.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Supplementary Information
Below is the link to the electronic supplementary material.
Rights and permissions
About this article
Cite this article
Miyoshi, M., Watanabe, N., Fukuda, T. et al. Left atrial appendage orifice dimensions in Japanese atrial fibrillation population measured by multiplane transesophageal echocardiography. J Echocardiogr 20, 201–207 (2022). https://doi.org/10.1007/s12574-022-00575-8
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s12574-022-00575-8