Clinical Significance of Left Atrial Anatomic Abnormalities Identified by Cardiac Computed Tomography


Purpose: The clinical significance of newly identified left atrial anatomic abnormalities (LAAA)— accessory appendages, diverticula, septal pouches—by multidetector CT (MDCT) remains unclear. Similar anatomical outpouchings, i.e., the left atrial appendage, have been associated with cardioembolisms and arrhythmia. To test the hypothesis that LAAA are also associated with increased risk of these events, we performed a retrospective analysis to examine the association of LAAA in patients undergoing CT with embolic events and arrhythmia. Methods: 242 patients (mean age 56 SD 12 years, 41% female) were selected who had CT coronary angiography performed with 64-row MDCT between 2007 and 2012 if complete clinical history records were available. CT images were independently reviewed for the presence of LAAA. Association of cerebrovascular accident (CVA) or transient ischemic attack (TIA), atrial fibrillation, and palpitations to LAAA was calculated using odds ratios (OR) with 95% confidence interval (CI) and Fisher’s exact test. Results: After adjusting for age, sex, hypertension, dyslipidemia and diabetes via multiple logistic regression, patients with accessory appendages are more likely to have reported palpitations (OR: 1.80; CI: 1.03 - 3.16). Patients with diverticula and septal pouches are significantly older than those without these abnormalities (p = 0.01 and p = 0.02, respectively). Septal pouches are associated with diabetes (OR: 2.29; 95%CI: 1.15 - 4.54). Conclusions: Accessory left atrial appendages are associated with palpitations. Patients with septal pouches and diverticula are significantly older than those patients without these anatomic abnormalities, suggesting age dependency of these findings. None of these anatomic abnormalities were associated with thromboembolic events after adjustment for potentially confounding comorbidities.

Share and Cite:

Vehian, A. , Choi, B. , Rekhi, S. , Young, H. , Dusaj, R. and Zeman, R. (2015) Clinical Significance of Left Atrial Anatomic Abnormalities Identified by Cardiac Computed Tomography. Advances in Computed Tomography, 4, 1-8. doi: 10.4236/act.2015.41001.

Conflicts of Interest

The authors declare no conflicts of interest.


[1] Raff, G.L., Gallagher, M.J., O’Neill, W.W., et al. (2005) Diagnostic Accuracy of Noninvasive Coronary Angiography Using 64-Slice Spiral Computed Tomography. Journal of the American College of Cardiology, 46, 552-557.
[2] Nikolaou, K., Flohr, T., Knez, A., et al. (2004) Advances in Cardiac CT Imaging: 64-Slice Scanner. The International Journal of Cardiovascular Imaging, 20, 535-540.
[3] Balli, O., Aytemir, K. and Karcaaltincaba, M. (2012) Multidetector CT of Left Atrium. European Journal of Radiology, 81, e37-e46.
[4] Saremi, F. and Krishnan, S. (2007) Cardiac Conduction System: Anatomic Landmarks Relevant to Interventional Electrophysiologic Techniques Demonstrated with 64-Detector CT. Radiographics, 27, 1539-1565.
[5] Krishnan, S.C. and Salazar, M. (2010) Septal Pouch in the Left Atrium: A New Anatomical Entity with Potential for Embolic Complications. JACC: Cardiovascular Interventions, 3, 98-104.
[6] Abbara, S., Mundo-Sagardia, J.A., Hoffmann, U., et al. (2009) Cardiac CT Assessment of Left Atrial Accessory Appendages and Diverticula. American Journal of Roentgenology, 193, 807-812.
[7] Duerinckx, A.J. and Vanovermeire, O. (2008) Accessory Appendages of the Left Atrium as Seen during 64-Slice Coronary CT Angiography. The International Journal of Cardiovascular Imaging, 24, 215-221.
[8] Hoey, E.T., Nagra, I. and Ganeshan, A. (2011) Cardiac Aneurysms and Diverticula: Magnetic Resonance and Computed Tomography Appearances. Current Problems in Diagnostic Radiology, 40, 72-84.
[9] Lazoura, O., Reddy, T., Shriharan, M., et al. (2012) Prevalence of Left Atrial Anatomical Abnormalities in Patients with Recurrent Atrial Fibrillation Compared with Patients in Sinus Rhythm Using Multi-Slice CT. Journal of Cardiovascular Computed Tomography, 6, 268-273.
[10] Lee, W.J., Chen, S.J., Lin, J.L., et al. (2008) Accessory Left Atrial Appendage: A Neglected Anomaly and Potential Cause of Embolic Stroke. Circulation, 117, 1351-1352.
[11] Wan, Y., He, Z., Zhang, L., Li, B.J., Sun, D.H., Fu, F., et al. (2009) The Anatomical Study of Left Atrium Diverticulum by Multi-Detector Row CT. Surgical and Radiologic Anatomy, 31, 191-198.
[12] Troupis, J., Crossett, M., Scneider-Kolsky, M. and Nandurkar, D. (2012) Presence of Accessory Left Atrial Appendage/Diverticula in a Population with Atrial Fibrillation Compared with Those in Sinus Rhythm: A Retrospective Review. The International Journal of Cardiovascular Imaging, 28, 375-380.
[13] Nagai, T., Fujii, A., Nishimura, K., Inoue, K., Suzuki, J., Kido, T., et al. (2011) Large Thrombus Originating from Left Atrial Diverticulum: A New Concern for Catheter Ablation of Atrial Fibrillation. Circulation, 124, 1086-1088.
[14] Blackshear, J.L. and Odell, J.A. (1996) Appendage Obliteration to Reduce Stroke in Cardiac Surgical Patients with Atrial Fibrillation. The Annals of Thoracic Surgery, 61, 755-759.
[15] Iwasaki, Y.K., Nishida, K., Kato, T. and Nattel, S. (2011) Atrial Fibrillation Pathophysiology: Implications for Management. Circulation, 124, 2264-2274.
[16] Killeen, R.P., O’Connor, S.A., Keane, D. and Dodd, J.D. (2009) Ectopic Focus in an Accessory Left Atrial Appendage Radiofrequency Ablation of Refractory Atrial Fibrillation. Circulation, 120, e60-e62.
[17] Naqvi, T.Z. and Zaky, J. (2004) Electric Dissociation within Left Atrial Appendage Diagnosed by Doppler Echocardiography. Journal of the American Society of Echocardiography, 17, 1077-1079.
[18] Breithardt, O.A., Papavassiliu, T. and Borggrefe, M. (2006) A Coronary Embolus Originating from the Interatrial Septum. European Heart Journal, 27, 2745.
[19] Seyfert, H., Bohlscheid, V. and Bauer, B. (2008) Double Atrial Septum with Persistent Interatrial Space and Transient Ischaemic Attack. European Journal of Echocardiography, 9, 707-708.
[20] Gurudevan, S.V., Shah, H., Tolstrup, K., Siegel, R. and Krishnan, S.C. (2010) Septal Thrombus in the Left Atrium: Is the Left Atrial Septal Pouch the Culprit? JACC: Cardiovascular Imaging, 3, 1284-1286.
[21] Killeen, R.P., Ryan, R., MacErlane, A., Martos, R., Keane, D. and Dodd, J.D. (2010) Accessory Left Atrial Diverticulae: Contractile Properties Depicted with 64-Slice Cine-Cardiac CT. The International Journal of Cardiovascular Imaging, 26, 241-248.
[22] Di Biase, L., Burkhardt, J.D., Mohanty, P., Sanchez, J., Mohanty, S., Horton, R., et al. (2010) Left Atrial Appendage: An Underrecognized Trigger Site of Atrial Fibrillation. Circulation, 122, 109-118.
[23] Wu, T.J., Yashima, M., Xie, F., Athill, C.A., Kim, Y.-H., Fishbein, M.C., et al. (1998) Role of Pectinate Muscle Bundles in the Generation and Maintenance of Intra-Atrial Reentry: Potential Implications for the Mechanism of Conversion between Atrial Fibrillation and Atrial Flutter. Circulation Research, 83, 448-462.
[24] Tugcu, A., Okajima, K., Jin, Z.Z., Rundek, T., Homma, S., Sacco, R.L., et al. (2010) Septal Pouch in the Left Atrium and Risk of Ischemic Stroke. JACC: Cardiovascular Imaging, 3, 1276-1283.
[25] From, A.M., Scott, C.G. and Chen, H.H. (2009) Changes in Diastolic Dysfunction in Diabetes Mellitus over Time. American Journal of Cardiology, 103, 1463-1466.
[26] Pritchett, A.M., Mahoney, D.W., Jacobsen, S.J., Rodeheffer, R.J., Karon, B.L. and Redfield, M.M. (2005) Diastolic Dysfunction and Left Atrial Volume: A Population-Based Study. Journal of the American College of Cardiology, 45, 87-92.
[27] Lee, W.J., Chen, S.J. and Wang, T.D. (2008) Multiple Accessory Left Atrial Appendages along a Semi-Circular Path. European Heart Journal, 29, 2447-2447.

Copyright © 2023 by authors and Scientific Research Publishing Inc.

Creative Commons License

This work and the related PDF file are licensed under a Creative Commons Attribution 4.0 International License.