‘Chicken Wing’ clue to stroke risk in atrial fibrillation

Aug 6 2012

By Eleanor McDermid, Senior MedWire Reporter

Patients with atrial fibrillation (AF) who have a Chicken Wing left atrial appendage (LAA) morphology are less likely to have a stroke than those with other morphologies, research suggests.

"These results are novel and could be clinically relevant, especially for patients currently judged to be at low risk of thromboembolic events, such as those with CHADS₂ scores of 0 and 1," say Andrea Natale (Texas Cardiac Arrhythmia Institute at St David's Medical Center, Austin, USA) and co-workers.

Among 932 patients scheduled for catheter ablation, just 4% of those with Chicken Wing LAA morphology had a previous stroke or transient ischemic attack (TIA), compared with 10%, 12%, and 18% of those with Windsock, Cactus, and Cauliflower morphologies, respectively. Almost all AF-related thrombi are thought to originate in the LAA.

"From a practical perspective, our data suggest that it is important to correctly recognize only patients with Chicken Wing LAA morphology, which is the most prevalent and easiest to detect," the researchers write in the Journal of the American College of Cardiology.

The Chicken Wing morphology was present in 48% of the cohort, followed by Cactus in 30%, Windsock in 19%, and Cauliflower in 3%.

In a multivariate analysis controlling for factors including gender and stroke risk according to CHADS₂ score, patients with the Chicken Wing LAA morphology were 79% less likely to have had a stroke or TIA than were patients with other morphologies. Conversely, patients with other morphologies were between four and eight times more likely to have a stroke or TIA than were those with the Chicken Wing morphology.

Natale et al gauged clinical stroke risk with the CHADS₂ score, rather than with the more recently proposed CHA₂DS₂VASc score, which has been adopted into European guidelines.

"Although a greater number of patients are required to use oral anticoagulation with this new score, the clinical decision making is still controversial in patients with a low-risk CHA₂DS₂-VASc score," say Natale and team. "The implementation of LAA morphology may aid the clinical decision toward oral anticoagulant or antiplatelet therapy."

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