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. 2019 Sep:46:10.22489/cinc.2019.439.
doi: 10.22489/cinc.2019.439. Epub 2020 Feb 24.

Interatrial Septum and Appendage Ostium in Atrial Fibrillation Patients: A Population Study

Anupama Goparaju  1 , Alan Morris  2 , Ibolya Csecs  2 , Riddhish Bhalodia  1 , Tom Ditter  3 , Kristine Fuimaono  3 , Evgueni Kholmovski  4 , Nassir Marrouche  2 , Joshua Cates  2 , Shireen Elhabian  1
Affiliations

Interatrial Septum and Appendage Ostium in Atrial Fibrillation Patients: A Population Study

Anupama Goparaju et al. Comput Cardiol (2010). 2019 Sep.

Abstract

Left atrial appendage (LAA) closure is performed in atrial fibrillation (AF) patients to help prevent stroke. LAA closure using an occlusion implant is performed under imaging guidance. However, occlusion can be a complicated process due to the highly variable and heterogeneous LAA shapes across patients. Patient-specific implant selection and insertion processes are keys to the success of the procedure, yet subjective in nature. A population study of the angle of entry at the interatrial septum relative to the appendage can assist in both catheter design and patient-specific implant choice. In our population study, we analyzed the inherent clusters of the angles that were obtained between the septum normal and the LAA ostium plane. The number of inherent angle clusters matched the LAA four morphological classifications reported in the literature. Further, our exploratory analysis revealed that the normal from the ostium plane does not intersect the septum in all the samples under study. The insights gained from this study can help assist in making objective decisions during LAA closure.

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Figures

Figure 1.
Figure 1.
Left atrial appendage closure using an implant and an access system.
Figure 2.
Figure 2.
Angle of septum normal relative to ostia plane
Figure 3.
Figure 3.
A two-dimensional projection of the clustered LAA shapes from signed distance transform images using t-distributed stochastic neighbor embedding (t-SNE).
Figure 4.
Figure 4.
Elbow method on the angles. Four clusters have been found to best explain the angle distribution.
Figure 5.
Figure 5.
Angle cluster distributions.
Figure 6.
Figure 6.
Angle distributions for LAA clusters.
Figure 7.
Figure 7.
Normal from ostium plane for LAA representative cluster samples.
See this image and copyright information in PMC

References

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