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. 2022 Oct 27;17(10):e0276369.
doi: 10.1371/journal.pone.0276369. eCollection 2022.

Is there an association between left atrial outpouching structures and recurrence of atrial fibrillation after catheter ablation?

Erkan Celik  1   2 , Nils Große Hokamp  2 , Lukas Goertz  2 , Wolfgang Fehske  3 , Dinh Quang Nguyen  3 , Lutz Lichtenberg  3 , Robert Peter Reimer  2 , David Maintz  2 , Christoph Düber  4 , Tobias Achenbach  1   5
Affiliations

Is there an association between left atrial outpouching structures and recurrence of atrial fibrillation after catheter ablation?

Erkan Celik et al. PLoS One. .

Abstract

Objective: The aim of this study was to investigate the impact of left atrial diverticula (LADs), left sided septal pouches (LSSPs) and middle right pulmonary veins (MRPVs) on recurrent atrial fibrillation (rAF) in patients undergoing laser pulmonary vein isolation procedure (PVI).

Material and methods: This retrospective study enrolled 139 patients with pre-procedural multiple detector computed tomography (MDCT) imaging and 12 months follow-up examination. LADs, LSSPs and MRPV were identified by two radiologists on a dedicated workstation using multiplanar reconstructions and volume rendering technique. Univariate and bivariate regression analyses with patient demographics and cardiovascular risk factors as covariates were performed to reveal independent factors associated with rAF.

Results: LADs were recorded in 41 patients (29%), LSSPs in 20 (14%) and MRPVs in 15 (11%). The right anterosuperior wall of the left atrium was the most prevalent location of LADs (68%). rAF occured in 20 patients, thereof, 15 exhibited an outpouching structure of the left atrium (LAD: 9, LSSP: 2 and MRPV: 3). Presence of an LAD (HR: 2.7, 95%CI: 1.0-8.4, p = 0.04) and permanent AF (HR: 4.8, 95%CI: 1.5-16.3, p = 0.01) were independently associated with rAF.

Conclusions: LAD, LSSP and MRPV were common findings on pre-procedural cardiac computed tomography. LADs were revealed as potential independent risk factor of rAF, which might be considered for treatment planning and post-treatment observation.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1
a.) Cardiac-CT of a 55 years old female patient with AF. The arrow shows a single left atrial diverticulum in the anterosuperior wall. b.) Cardiac-CT of a 54 years old female patient with AF. The arrow shows a left-sided septal pouch. c.) + d.) Cardiac-CT and three-dimensional volume rendering of the heart of a 44 years old male patient with AF. The arrows (white and black) show an accessory pulmonary vein merging into the left atrium from the right.
Fig 2
Fig 2. Overview of the total amount of left atrial diverticula and their localisation.
See this image and copyright information in PMC

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