Study In The Anatomy And Morphology In Patients With Paroxysmal Atrial Fibrillation

BackgroundParoxysmal atrial fibrillation(PAF)is not an uncommon arrhythmia in clinic. During PAF,left atria(LA) loss its regular and coordinated contraction, which causes a blood stasis within the atria, and with a hypercoagulable state,the LA has an increased propensity to form blood clots. The incidence rate of stroke in patients with PAF is1.3%-2.0%per year,as it may be asymptomatic in PAF,many patients did not get an effective treatment in time.In current, studies show that there is similar stroke incidence between PAF and permanent AF. The thrombus was mainly originated from LAA(left atrial appendage) in caridoembolic stroke,and there are some changes in the structure and function of LA A.ObjectiveTo explore the anatomical and morphological characteristics in patients with PAF and provide a direction for LAA occlusion.Methods46patients with AF prior to RFCA(radiofrequency catheter ablation)and92patients in snus rhythm were enrolled prospectively from15th December2012and15th April, all patients were performed with CTCA(CT coronary angiography),postprocedure images were analysed, the morphology of LAA were classified into different types and related anatomical datas were measured.Results1. LAA morphology:Chicken-wing (55,9.9%), Cauliflower(40,29%), Cactus(17,12.3%), Windsock(26,18.8%).2. Anatomical relationship of the orifice of left atrial appendage to left superior pulmonary vein(LSPV):high type (superior to LSPV,2.2%), middle type(parallel to LSPV,70.3%), low type(inferior to LSPV,27.5%). 3. LAA orifice morphology:oval(122,88.4%), round-like(12,8.7%)and drop-like(4,2.9%).4. Analysis of anatomical parameter values:(1) Patients with atrial fibrillation have a larger LAA volume than who with sinus rhythm. Patients with PAF have a larger LA volume(97.32±26.12cm3vs85.67±17.87cm3), a larger LAA volume (10.88±4.09cm3vs9.20±3.33cm3) and a larger diameter of LAA (26.42±4.70mm vs24.05±5.02mm) orifice than patients with sinus rhythm.(2) There is a slightly positive correlation between LAV and LAAV, and the correlation coefficient(r) is0.291(P<0.01). there is a moderate positive relationship between LAA orifice area and LAAV, r=0.869(P<0.001)(3) There is no significant correlation between age and LAAV, and there was no significant gender differences in LAAV.(4) The proportion of LAAV/LAV is10.96±3.85%.ConclusionsLAA has a complicated structure with large heterogeneity. Patients with PAF have a larger LAAV than patients with sinus rhythm.