Use of computed tomography to identify atrial fibrillation associated differences in left atrial wall thickness and density

Thomas A. Dewland, Max Wintermark, Anna Vaysman, Lisa M. Smith, Elizabeth Tong, Eric Vittinghoff, Gregory M. Marcus

Research output: Contribution to journalArticlepeer-review

18 Scopus citations


Introduction Left atrial (LA) tissue characteristics may play an important role in atrial fibrillation (AF) induction and perpetuation. Although frequently used in clinical practice, computed tomography (CT) has not been employed to describe differences in LA wall properties between AF patients and controls. We sought to noninvasively characterize AF-associated differences in LA tissue using CT. Methods CT images of the LA were obtained in 98 consecutive patients undergoing AF ablation and in 89 controls. A custom software algorithm was used to measure wall thickness and density in four prespecified regions of the LA. Results On average, LA walls were thinner (-15.5%, 95% confidence interval [CI] -23.2 to -7.8%, P < 0.001) and demonstrated significantly lower density (-19.7 Hounsfield Units [HU], 95% CI -27.0 to -12.5 HU, P < 0.001) in AF patients compared to controls. In linear mixed models adjusting for demographics, clinical variables, and other CT measurements, the average LA, interatrial septum, LA appendage, and anterior walls remained significantly thinner in AF patients. After adjusting for the same potential confounders, history of AF was associated with reduced density in the LA anterior wall and increased density below the right inferior pulmonary vein and in the LA appendage. Conclusion Application of an automated measurement algorithm to CT imaging of the atrium identified significant thinning of the LA wall and regional alterations in tissue density in patients with a history of AF. These findings suggest differences in LA tissue composition can be noninvasively identified and quantified using CT.

Original languageEnglish (US)
Pages (from-to)55-62
Number of pages8
JournalPACE - Pacing and Clinical Electrophysiology
Issue number1
StatePublished - Jan 2013
Externally publishedYes


  • atrial fibrillation
  • atrium
  • computed tomography
  • imaging

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine


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