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Review article
Submitted: 2023-05-05
Accepted: 2023-07-09
Published online: 2023-07-26
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Anatomy of the right atrial appendage and its importance in clinical practice

Jiani Zhang1, Mingyuan Yuan1
Affiliations
  1. Department of Radiology, Shanghai University of Medicine and Health Sciences Affiliated Zhoupu Hospital No. 1500, Shanghai, China

open access

Ahead of Print
REVIEW ARTICLES
Submitted: 2023-05-05
Accepted: 2023-07-09
Published online: 2023-07-26

Abstract

The right atrial appendage is an important anatomical marker of the right heart. With the developments in cardiology, more attention has been paid to the right atrial appendage. This article summarizes the progress in research regarding the right atrial appendage anatomy and its clinical value, to collate and augment the relevant data. The shape of the right atrial appendage differs from the left atrial appendage: its outer surface is relatively flat and its internal structure comprises a terminal crest and musculi pectinati. In clinical interventional therapy, the right atrial appendage is often used as the electrode implantation site. The thickness of the musculi pectinati and the wall thickness of the right atrial appendage are closely related to the outcomes in atrial lead implantation. In terms of atrial fibrillation, wherein thrombi formation is frequent, the right atrial appendage is one of the predilection sites of thrombosis. However, the incidence of thrombosis in the right atrial appendage is lower than that in the left atrial appendage. Familiarity with the anatomy of the right atrial appendage is of prime importance in atrial lead implantation, and the role of the right atrial appendage in atrial fibrillation requires further investigation.

Abstract

The right atrial appendage is an important anatomical marker of the right heart. With the developments in cardiology, more attention has been paid to the right atrial appendage. This article summarizes the progress in research regarding the right atrial appendage anatomy and its clinical value, to collate and augment the relevant data. The shape of the right atrial appendage differs from the left atrial appendage: its outer surface is relatively flat and its internal structure comprises a terminal crest and musculi pectinati. In clinical interventional therapy, the right atrial appendage is often used as the electrode implantation site. The thickness of the musculi pectinati and the wall thickness of the right atrial appendage are closely related to the outcomes in atrial lead implantation. In terms of atrial fibrillation, wherein thrombi formation is frequent, the right atrial appendage is one of the predilection sites of thrombosis. However, the incidence of thrombosis in the right atrial appendage is lower than that in the left atrial appendage. Familiarity with the anatomy of the right atrial appendage is of prime importance in atrial lead implantation, and the role of the right atrial appendage in atrial fibrillation requires further investigation.

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Keywords

thrombosis, progress, atrial lead, atrial fibrillation

About this article
Title

Anatomy of the right atrial appendage and its importance in clinical practice

Journal

Folia Morphologica

Issue

Ahead of Print

Article type

Review article

Published online

2023-07-26

Page views

356

Article views/downloads

648

DOI

10.5603/FM.a2023.0047

Pubmed

37519049

Keywords

thrombosis
progress
atrial lead
atrial fibrillation

Authors

Jiani Zhang
Mingyuan Yuan

References (30)
  1. Anderson RH, Cook AC. The structure and components of the atrial chambers. Europace. 2007; 9 Suppl 6: vi3–vi9.
  2. Anfinogenova ND, Vasiltseva OY, Vrublevsky AV, et al. Right atrial thrombosis and pulmonary embolism: a narrative review. Semin Thromb Hemost. 2020; 46(8): 895–907.
  3. Anselmino M, Scaglione M, Di Biase L, et al. Left atrial appendage morphology and silent cerebral ischemia in patients with atrial fibrillation. Heart Rhythm. 2014; 11(1): 2–7.
  4. Arisha MJ, Hsiung MC, Nanda NC, et al. Two- and three-dimensional transthoracic echocardiographic assessment of superior vena cava, crista terminalis, and right atrial appendage using the right parasternal approach. Echocardiography. 2017; 34(12): 1919–1929.
  5. Ausma J, Wijffels M, Thoné F, et al. Structural changes of atrial myocardium due to sustained atrial fibrillation in the goat. Circulation. 1997; 96(9): 3157–3163.
  6. de Divitiis M, Omran H, Rabahieh R, et al. Right atrial appendage thrombosis in atrial fibrillation: its frequency and its clinical predictors. Am J Cardiol. 1999; 84(9): 1023–1028.
  7. Di Biase L, Santangeli P, Anselmino M, et al. Does the left atrial appendage morphology correlate with the risk of stroke in patients with atrial fibrillation? Results from a multicenter study. J Am Coll Cardiol. 2012; 60(6): 531–538.
  8. Ghodsi S, Taghi S, Alizadeh-Sani Z, et al. Association of COVID-19 infection with large thrombi in left and right atrial appendages. Egypt Heart J. 2021; 73(1): 81.
  9. Hao Y, Li Y, Liao D, et al. A comparative analysis of the effectiveness of active versus passive atrial lead fixation in Chinese patients with cardiac implantable electrical devices: a long term, retrospective, observational, single-center study. Curr Med Res Opin. 2017; 33(3): 573–578.
  10. Hołda J, Słodowska K, Strona M, et al. Mutual arrangements of coronary blood vessels within the right atrial appendage vestibule. J Clin Med. 2021; 10(16).
  11. Hołda J, Słodowska K, Tyrak K, et al. Topographical anatomy of the right atrial appendage vestibule and its isthmuses. J Cardiovasc Electrophysiol. 2020; 31(12): 3199–3206.
  12. Kamiński R, Grzybiak M, Nowicka E, et al. Macroscopic morphology of right atrial appendage in humans. Kardiol Pol. 2015; 73(3): 183–187.
  13. Kruse IB, Rydén L, Ydse B. A new lead for transvenous atrial pacing and sensing. Clinical and electrophysiological experiences. Pacing Clin Electrophysiol. 1980; 3(4): 395–405.
  14. Li CY, Gao BL, Pan T, et al. Morphologic classification of the right auricule on 256-slice computed tomography. Surg Radiol Anat. 2017; 39(6): 657–662.
  15. Li CY, Gao BL, Pan T, et al. Quantitative analysis of the right auricle with 256-slice computed tomography. Surg Radiol Anat. 2017; 39(4): 383–391.
  16. Loukas M, Tubbs RS, Tongson JM, et al. The clinical anatomy of the crista terminalis, pectinate muscles and the teniae sagittalis. Ann Anat. 2008; 190(1): 81–87.
  17. Manolis AS, Varriale P, Baptist SJ. Necropsy study of right atrial appendage: morphology and quantitative measurements. Clin Cardiol. 1988; 11(11): 788–792.
  18. Nakamura R, Yamauchi Y, Okishige K, et al. Extremely late asymptomatic atrial lead dislodgement from the right atrial appendage to superior vena cava with autopsy findings. HeartRhythm Case Rep. 2020; 6(10): 741–744.
  19. Peker K, Inal A, Sayar I, et al. Prevention of intraabdominal adhesions by local and systemic administration of immunosuppressive drugs. Iran Red Crescent Med J. 2013; 15(12): e14148.
  20. Petersen M, Roehrich A, Balzer J, et al. Left atrial appendage morphology is closely associated with specific echocardiographic flow pattern in patients with atrial fibrillation. Europace. 2015; 17(4): 539–545.
  21. Pothineni NV, Kancharla K, Katoor AJ, et al. Coronary artery injury related to catheter ablation of cardiac arrhythmias: A systematic review. J Cardiovasc Electrophysiol. 2019; 30(1): 92–101.
  22. Rissi R, Marques MJ, Neto HS. Checking the shape and lobation of the right atrial appendage in view of their clinical relevance. Anat Sci Int. 2019; 94(4): 324–329.
  23. Sánchez-Quintana D, Anderson RH, Cabrera JA, et al. The terminal crest: morphological features relevant to electrophysiology. Heart. 2002; 88(4): 406–411.
  24. Siddiqui AU, Daimi SR, Gandhi KR, et al. Crista terminalis, musculi pectinati, and taenia sagittalis: anatomical observations and applied significance. ISRN Anat. 2013; 2013: 803853.
  25. Sivakumaran S, Irwin ME, Gulamhusein SS, et al. Postpacemaker implant pericarditis: incidence and outcomes with active-fixation leads. Pacing Clin Electrophysiol. 2002; 25(5): 833–837.
  26. Subramaniam B, Riley MF, Panzica PJ, et al. Transesophageal echocardiographic assessment of right atrial appendage anatomy and function: comparison with the left atrial appendage and implications for local thrombus formation. J Am Soc Echocardiogr. 2006; 19(4): 429–433.
  27. Ueda A, McCarthy KP, Sánchez-Quintana D, et al. Right atrial appendage and vestibule: further anatomical insights with implications for invasive electrophysiology. Europace. 2013; 15(5): 728–734.
  28. Wang M, Siu CW, Lee KLf, et al. Effects of right low atrial septal vs. right atrial appendage pacing on atrial mechanical function and dyssynchrony in patients with sinus node dysfunction and paroxysmal atrial fibrillation. Europace. 2011; 13(9): 1268–1274.
  29. Witt CM, Lenz CJ, Shih HH, et al. Right atrial lead fixation type and lead position are associated with significant variation in complications. J Interv Card Electrophysiol. 2016; 47(3): 313–319.
  30. Zoppo F, Rizzo S, Corrado A, et al. Morphology of right atrial appendage for permanent atrial pacing and risk of iatrogenic perforation of the aorta by active fixation lead. Heart Rhythm. 2015; 12(4): 744–750.

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