Congenital Absence of Left Atrial Appendage Diagnosed by Multimodality Imaging

Abstract

A 70-years-old male with a history of hypertension and drug resistant paroxysmal atrial fibrillation (AF) presented to our hospital for catheter ablation to his symptomatic AF. He had no prior surgical or percutaneous procedure to close or exclude the left atrial appendage (LAA). A transesophageal echocardiography (TEE) was performed to rule out intra-cardiac thrombus prior to the ablation procedure. Although the TEE imaging at multiple acquisition angles was obtained, the LAA could not be visualized and an absence of the LAA was suspected. An absence of the LAA was confirmed using cardiac computed tomography (CT), which included 3D reconstruction. Additionally, the LAA was not visualized with left atrium (LA) angiography. During the ablation procedure, 3D voltage mapping in LA was created and no low voltage area or abnormal potential was recorded around the usual root location of the LAA. Successful electrical pulmonary vein isolation was achieved with no major complications. After six months of follow-up, the patient remained in sinus rhythm without any antiarrhythmic drugs and showed no related clinical symptoms. He stopped his anticoagulation therapy due to lack of evidence of AF recurrence and an absence of LAA. Multimodality imaging allowed us to identify the congenital absence of LAA.

Feasibility and Safety of Left Atrial Appendage Closure Using the LAmbre Device in Patients with Nonvalvular Atrial Fibrillation with or Without Prior Catheter Ablation

“…All the patients were evaluated by an electrophysiologist in the outpatient clinic for eligibility, and all the participants signed a written consent form. Transesophageal echocardiography (TEE) was performed to assess LAA anatomy, and exclude LAA thrombus and significant structural cardiac abnormalities such as congenital absence 24) in all the patients within 1 week before the LAAC procedure. All the data were collected prospectively by means of a web-based database.…”

Absence of Left Atrial Appendage in an Atrial Fibrillation Patient: Congenital or Acquired?

“…Enomoto Y et al diagnosed a case of an absent LAA and recorded no low-voltage areas or abnormal potentials around the usual root location of the LAA on 3-dimensional voltage mapping. 6 Absence of the LAA seems to be congenital according to existing reports. 2,6 The notable finding in our case that differentiates it from others is that we recorded abnormal potentials around the usual root location of the LAA using a 3-dimensional mapping system.…”

“…6 Absence of the LAA seems to be congenital according to existing reports. 2,6 The notable finding in our case that differentiates it from others is that we recorded abnormal potentials around the usual root location of the LAA using a 3-dimensional mapping system. In our case, voltage mapping indicated that there were large areas of low-voltage electrograms and scar tissue on the anterior wall.…”

Rudimentary left atrial appendage in atrial fibrillation, congenital occlusion device, or continued thrombotic risk

“… 3 It has been previously postulated, though not proven, that congenital absence of LAA could infer a reduced thromboembolic risk similar to LAA occlusion. 4 However, limited outcome data or discussion of rudimentary appendages has been published. Given the uncertain thromboembolic risk associated with rudimentary LAA, anticoagulation decisions should be based on individual risk assessment.…”