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Editorials |

Left Atrial Appendage Myopathy : The Importance of Serial Transesophageal Assessment in Atrial Fibrillation

Charles Pollick, MD
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Affiliations: Los Angeles, CA 
 ,  Dr. Pollick is Director, Non-Invasive Cardiology, Good Samaritan Hospital, and Associate Clinical Professor, UCLA School of Medicine.

Correspondence to: Charles Pollick, MD, Los Angeles Cardiology Associates, 1245 Wilshire Blvd, Suite 703, Los Angeles, CA 90017; e-mail: Cpollick@lacard.com



Chest. 2000;117(2):297-298. doi:10.1378/chest.117.2.297
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It has been estimated that 2.2 million Americans have atrial fibrillation (AF).1 The incidence of AF rises progressively with age from 0.5% for the 50- to 59-year age group to almost 9% for the 80- to 89-year age group.2 The risk of stroke in patients with AF depends on associated etiology; it is 17-fold with rheumatic heart disease and four- to fivefold in nonrheumatic patients compared to similar age cohorts in sinus rhythm.3 Age is an independent risk factor.45 In “lone” AF (no associated valve disease, hypertension, cardiomyopathy, or ischemic heart disease), the risk of stroke at age < 60 years is negligible, but in patients > 80 years old, it climbs to 3% per year.5 In the Framingham study (which looked at nonrheumatic AF that included valve disease and hypertension), the annual incidence of stroke in patients > 80 years old was reported to be as high as 7%.4 The presumed cause of stroke in the majority of these patients is embolization of thrombus from the left atrial appendage (LAA): the pathologic association of AF with LAA thrombus has been acknowledged for just over 30 years.6 The cerebral infarct caused by AF is frequently large, often produced by the occlusion of a major cerebral artery, resulting in a severe or fatal stroke.7 In a series of hospitalized patients with stroke associated with AF, 71% died or had a severe permanent neurologic deficit.8

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