Few data are available on left atrial appendage (LAA) remodeling using three-dimensional (3D) transoesophageal echocardiography (TEE) in patients in atrial fibrillation (AF). The aim of this study was to evaluate LAA thrombogenic milieu, LAA velocities, spontaneous echocardiographic contrast/thrombus, 3D LAA geometry and volume in AF.

We prospectively evaluated patients 206 hospitalized for AF with two-dimensional (2D) transthoracic and 3D TEE of the LAA within 24hours of admission. 3D parameters were off-line analysed using Tomtec software (4D Cardio-View, Generic Volume, Philips) (Fig. 1). Patients were divided into two groups according to the type of AF at admission: paroxysmal AF (62 patients) or persistent AF (144 patients).

Patients with persistent AF had higher BMI, more prevalent hypertension and diabetes, as well as history of AF, heart failure, renal failure. They had also higher CHA2DS2-VASc. Patients with persistent AF at admission had lower LVEF, higher left atrial volume, higher E and E/e′ and pulmonary arterial systolic pressure. Patients with persistent AF had more severe LAA spontaneous echo contrast/sludge, lower LAA emptying and filling flow velocity, and higher 3D LAA measurements (ostium area, length, volume) (Table 1).

3D evaluation of the LAA may reflect atrial remodeling in AF and seems to be associated with the burden of AF. Follow-up data are needed to determine the impact of such abnormalities in the risk stratification of such patients.