Indian Researchers Redefine Role of Left Atrial Appendage in Stroke Prevention: Apollo Medicine Review
India: A growing body of research is redefining the clinical significance of the left atrial appendage (LAA), once considered a vestigial cardiac structure. A new review article published in Apollo Medicine by Dr. Pushpendra Nath Renjen and colleagues from the Institute of Neurosciences, Indraprastha Apollo Hospitals, New Delhi, explores how this small, pouch-like extension of the left atrium plays a major role in the pathogenesis of stroke and heart disease.
Speaking to Medical Dialogues about the motivation behind the study, Dr. Renjen shared, “I have been interested and recently published a paper in Neurology Asia on atrial cardiopathy before clinical atrial fibrillation (AF) is detected and documented. There are structural and hemodynamic changes that occur in the left atrium before AF becomes clinically evident. The left atrial appendage, a small projection of the atrium, is the source of embolization in nearly 90% of cases.”
The article highlights that the LAA plays a pivotal role in thrombogenesis and arrhythmogenesis, especially in patients with atrial fibrillation, where it serves as the predominant site for thrombus formation. The morphology of the LAA has been found to influence stroke risk, with four major types described by Dr. Wang: Wind Sock, Chicken Wing, Cauliflower, and Cactus. According to Dr. Renjen, “Among these, the Chicken Wing morphology is the most common and is associated with a higher risk of embolism, accounting for up to 40% of cases.”
The study emphasizes the need for clinicians to routinely assess the LAA when evaluating patients with stroke or suspected cardioembolic events. “Assessment of the LAA should become a standard part of stroke evaluation,” Dr. Renjen noted. “Techniques such as Transesophageal Echocardiography (TEE), Intracardiac Echocardiography, Cardiac CT, and Cardiac MRI allow for detailed evaluation of thrombus formation, anatomical variations, and potential embolic sources.”
In terms of management, the article discusses the growing significance of LAA closure devices in stroke prevention. Traditional anticoagulation with warfarin or direct oral anticoagulants (DOACs) remains the first-line strategy, but challenges like bleeding risk and patient adherence have encouraged alternative approaches. “Managing LAA thrombus has become crucial in stroke prevention,” Dr. Renjen explained. “This has led to the development of LAA closure devices such as the Watchman, which have demonstrated significant benefits. Although randomized controlled trials have shown that LAA closure is non-inferior to oral anticoagulants, the long-term outcomes continue to be evaluated.”
Looking ahead, Dr. Renjen believes that the future of stroke prevention lies in early identification of atrial cardiopathy before the onset of atrial fibrillation. “Developing reliable methods to detect atrial structural or electrical abnormalities at an early stage could significantly influence long-term management strategies and reduce the risk of embolic stroke, "he said.
"Overall, the article highlights the evolving understanding of the LAA as more than just an anatomical bystander. With advancements in imaging, growing clinical evidence, and innovative treatment options, the left atrial appendage is a critical focus in ongoing efforts to prevent stroke and improve cardiac care," the authors concluded.
Reference:
Saeed, N., Renjen, P. N., Chaudhari, D. M., Mahmood, M. A., & Goswami, A. (2025). The Hidden Reservoir: Rethinking Left Atrial Appendage in Stroke. Apollo Medicine. https://doi.org/10.1177/09760016251347355
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