Clinical Significance of Left Atrial Anatomic Abnormalities
CT Coronary Angiography (CTCA) has been established as the gold standard for non-invasive definition of coronary anatomy . In addition, electrocardiographically-gated (ECG) multidetector CT (MDCT) scans have allowed for unprecedented three-dimensional spatial resolution for morphologic evaluation of the left atrium . As a result of constant enhancement in MDCT imaging, numerous previously undescribed left atrial anatomic abnormalities (LAAA) including accessory appendages, diverticula and septal pouches have been identified with remarkably high prevalence.The discovery of these LAAA is relatively new; however, their clinical significance remains unclear.

Better understanding of LAAA has the potential to enhance management and reduce their potential complications. Additionally, proper identification of these structures radiographically is essential, as they can often be mistaken for post-ablation injuries rather than anatomic variants. Atrial fibrillation originating from the left atrium has been implicated in cerebrovascular accidents (CVA) and transient ischemic attacks (TIA) . Recently, ectopic fibrillatory activity and thrombus has been described in patients with accessory appendages and diverticula.

Septal pouches, given their blind end morphology, have been implicated in case reports of throm- boembolic disease as well as arrhythmia .We performed a blinded retrospective analysis in a series of patients who underwent CTCA to determine the clinical significance of these LAAA with regards to embolic potential and arrhythmogenic burden with the hypothesis that the presence LAAA is associated with these clinical findings. Patients with the presence of LAAA were reviewed for the presence of embolic events as well as occurrence of documented arrhythmia and palpitations and were compared to a control group of scanned patients without LAAA.

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