{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T20:18:26Z","timestamp":1791317906727,"version":"4.3.1"},"reference-count":24,"publisher":"MDPI AG","issue":"20","license":[{"start":{"date-parts":[[2025,10,20]],"date-time":"2025-10-20T00:00:00Z","timestamp":1760918400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>Background\/Objectives: Left atrial appendage (LAA) morphology has been implicated in atrial fibrillation (AF) recurrence following catheter ablation. However, the predictive value of specific anatomical shapes remains unclear. We aimed to evaluate the association between distinct LAA morphologies and AF recurrence post-ablation. Methods: In this retrospective, single-center study, 463 patients with AF undergoing first-time catheter ablation were included. Pre-ablation contrast-enhanced cardiac computed tomography was performed to classify LAA morphology into chicken-wing, windsock, cauliflower, and cactus types. Patients were followed for one year, with AF recurrence defined as documented atrial tachyarrhythmia episodes lasting more than 30 s occurring between 3 and 12 months post-procedure. Clinical, anatomical, and procedural factors were analyzed using multivariable logistic regression to identify independent predictors of recurrence. Results: Among the four morphologies, the windsock-type LAA had the highest recurrence rate at 48.3%, significantly greater than chicken-wing (25.2%), cauliflower (20.8%), and cactus (18.2%) types (p = 0.017). Multivariable analysis confirmed windsock morphology as an independent predictor for AF recurrence (adjusted OR = 2.720, 95% CI: 1.209\u20136.118; p = 0.016). Additionally, persistent AF (adjusted OR = 1.748, 95% CI: 1.075\u20132.842; p = 0.024) and antiarrhythmic drug use in the blanking period (adjusted OR = 2.862, 95% CI: 1.689\u20134.849; p &lt; 0.001) independently increased the risk of recurrence. Conclusions: Windsock-type LAA morphology significantly predicts increased AF recurrence following catheter ablation, underscoring the importance of morphological assessment in ablation planning. Individualized strategies targeting high-risk LAA morphologies may enhance procedural success and reduce AF recurrence. Future prospective studies are warranted to validate these findings.<\/jats:p>","DOI":"10.3390\/diagnostics15202642","type":"journal-article","created":{"date-parts":[[2025,10,20]],"date-time":"2025-10-20T12:27:29Z","timestamp":1760963249000},"page":"2642","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Left Atrial Appendage Morphology Predicts Atrial Fibrillation Recurrence: The Hidden Risks of Windsock Anatomy"],"prefix":"10.3390","volume":"15","author":[{"given":"Yu-Sheng","family":"Lin","sequence":"first","affiliation":[{"name":"Section of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 833401, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hui-Ting","family":"Wang","sequence":"additional","affiliation":[{"name":"Emergency Department, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 833401, Taiwan"},{"name":"School of Medicine, College of Medicine, National Sun Yat-Sen University, Kaohsiung 804201, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yen-Nan","family":"Fang","sequence":"additional","affiliation":[{"name":"Section of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 833401, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4423-9246","authenticated-orcid":false,"given":"Huang-Chung","family":"Chen","sequence":"additional","affiliation":[{"name":"Section of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 833401, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yi-Wei","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Radiology, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 833401, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7465-0880","authenticated-orcid":false,"given":"Yung-Lung","family":"Chen","sequence":"additional","affiliation":[{"name":"Section of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 833401, Taiwan"},{"name":"School of Medicine, College of Medicine, National Sun Yat-Sen University, Kaohsiung 804201, Taiwan"},{"name":"Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan 333323, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,10,20]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"109","DOI":"10.1161\/CIRCULATIONAHA.109.928903","article-title":"Left atrial appendage: An underrecognized trigger site of atrial fibrillation","volume":"122","author":"Burkhardt","year":"2010","journal-title":"Circulation"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1929","DOI":"10.1016\/j.jacc.2016.07.770","article-title":"Left Atrial Appendage Isolation in Patients With Longstanding Persistent AF Undergoing Catheter Ablation: BELIEF Trial","volume":"68","author":"Burkhardt","year":"2016","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1019","DOI":"10.1016\/j.jacc.2019.06.045","article-title":"Stroke Risk in Patients With Atrial Fibrillation Undergoing Electrical Isolation of the Left Atrial Appendage","volume":"74","author":"Mohanty","year":"2019","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"60","DOI":"10.14503\/THIJ-19-7061","article-title":"Left Atrial Appendage Closure and Pulmonary Vein Isolation","volume":"47","author":"Rasekh","year":"2020","journal-title":"Tex. Heart Inst. J."},{"key":"ref_5","first-page":"euae035","article-title":"Practical guide on left atrial appendage closure for the non-implanting physician: An international consensus paper","volume":"26","author":"Potpara","year":"2024","journal-title":"EP Eur."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1152","DOI":"10.1111\/jce.15889","article-title":"Incidental left atrial appendage isolation after catheter ablation of persistent atrial fibrillation: Mechanisms and long-term risk of thromboembolism","volume":"34","author":"Ghannam","year":"2023","journal-title":"J. Cardiovasc. Electrophysiol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"e001581","DOI":"10.1161\/JAHA.114.001581","article-title":"Left atrial appendage ligation in patients with atrial fibrillation leads to a decrease in atrial dispersion","volume":"4","author":"Kawamura","year":"2015","journal-title":"J. Am. Heart Assoc."},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"Cunha, P.S., Laranjo, S., Heijman, J., and Oliveira, M.M. (2022). The Atrium in Atrial Fibrillation\u2014A Clinical Review on How to Manage Atrial Fibrotic Substrates. Front. Cardiovasc. Med., 9.","DOI":"10.3389\/fcvm.2022.879984"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"29","DOI":"10.1186\/s43044-023-00356-3","article-title":"Left atrial appendage morphofunctional indices could be predictive of arrhythmia recurrence post-atrial fibrillation ablation: A meta-analysis","volume":"75","author":"Papathanasiou","year":"2023","journal-title":"Egypt. Heart J."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"273","DOI":"10.1002\/clc.23748","article-title":"Left atrial appendage size is a marker of atrial fibrillation recurrence after radiofrequency catheter ablation in patients with persistent atrial fibrillation","volume":"45","author":"Simon","year":"2022","journal-title":"Clin. Cardiol."},{"key":"ref_11","doi-asserted-by":"crossref","unstructured":"Gong, S., Zhou, J., Li, B., Kang, S., Ma, X., Cai, Y., Guo, Y., Hu, R., and Zhang, X. (2021). The Association of Left Atrial Appendage Morphology to Atrial Fibrillation Recurrence After Radiofrequency Ablation. Front. Cardiovasc. Med., 8.","DOI":"10.3389\/fcvm.2021.677885"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"973","DOI":"10.1111\/j.1540-8167.2010.01814.x","article-title":"Left atrial appendage studied by computed tomography to help planning for appendage closure device placement","volume":"21","author":"Wang","year":"2010","journal-title":"J. Cardiovasc. Electrophysiol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1251","DOI":"10.1016\/j.jcmg.2014.08.009","article-title":"The left atrial appendage: Anatomy, function, and noninvasive evaluation","volume":"7","author":"Beigel","year":"2014","journal-title":"JACC Cardiovasc. Imaging"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"1853","DOI":"10.1016\/j.hrthm.2011.07.013","article-title":"Localized reentry within the left atrial appendage: Arrhythmogenic role in patients undergoing ablation of persistent atrial fibrillation","volume":"8","author":"Hocini","year":"2011","journal-title":"Heart Rhythm."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"403","DOI":"10.1016\/j.jacep.2016.06.006","article-title":"Left Atrial Appendage: Embryology, Anatomy, Physiology, Arrhythmia and Therapeutic Intervention","volume":"2","author":"Naksuk","year":"2016","journal-title":"JACC Clin. Electrophysiol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"531","DOI":"10.1016\/j.jacc.2012.04.032","article-title":"Does the left atrial appendage morphology correlate with the risk of stroke in patients with atrial fibrillation? Results from a multicenter study","volume":"60","author":"Santangeli","year":"2012","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"2183","DOI":"10.4022\/jafib.2183","article-title":"Left Atrial Appendage Morphology as a Determinant for Stroke Risk Assessment in Atrial Fibrillation Patients: Systematic Review and Meta-Analysis","volume":"12","author":"Anan","year":"2019","journal-title":"J. Atr. Fibrillation"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"9","DOI":"10.1007\/s10840-015-0030-4","article-title":"Does left atrial appendage closure improve the success of pulmonary vein isolation? Results of a randomized clinical trial","volume":"44","author":"Romanov","year":"2015","journal-title":"J. Interv. Card. Electrophysiol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"21","DOI":"10.1016\/j.jacep.2019.08.012","article-title":"Incidence of Left Atrial Appendage Triggers in Patients With Atrial Fibrillation Undergoing Catheter Ablation","volume":"6","author":"Liang","year":"2020","journal-title":"JACC Clin. Electrophysiol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1746","DOI":"10.1016\/j.hrthm.2018.09.012","article-title":"Electrical isolation of the left atrial appendage increases the risk of ischemic stroke and transient ischemic attack regardless of postisolation flow velocity","volume":"15","author":"Kim","year":"2018","journal-title":"Heart Rhythm."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"366","DOI":"10.1093\/europace\/euac167","article-title":"Long-term outcomes of left atrial appendage isolation using cryoballoon in persistent atrial fibrillation","volume":"25","author":"Yorgun","year":"2023","journal-title":"Europace"},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"Pongratz, J., Riess, L., Hartl, S., Brueck, B., Tesche, C., Ebersberger, U., Helmberger, T., Crispin, A., Wankerl, M., and Dorwarth, U. (2023). Left atrial appendage volume is an independent predictor of atrial arrhythmia recurrence following cryoballoon pulmonary vein isolation in persistent atrial fibrillation. Front. Cardiovasc. Med., 10.","DOI":"10.3389\/fcvm.2023.1190860"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"1053","DOI":"10.1056\/NEJMc2111008","article-title":"Left Atrial Appendage Occlusion during Cardiac Surgery to Prevent Stroke. Reply","volume":"385","author":"Connolly","year":"2021","journal-title":"N. Engl. J. Med."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"47","DOI":"10.1016\/j.jjcc.2024.05.007","article-title":"Atrial structural remodeling and atrial fibrillation substrate: A histopathological perspective","volume":"85","author":"Yamaguchi","year":"2025","journal-title":"J. Cardiol."}],"container-title":["Diagnostics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-4418\/15\/20\/2642\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,20]],"date-time":"2025-10-20T12:53:17Z","timestamp":1760964797000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-4418\/15\/20\/2642"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,10,20]]},"references-count":24,"journal-issue":{"issue":"20","published-online":{"date-parts":[[2025,10]]}},"alternative-id":["diagnostics15202642"],"URL":"https:\/\/doi.org\/10.3390\/diagnostics15202642","relation":{},"ISSN":["2075-4418"],"issn-type":[{"value":"2075-4418","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,10,20]]}}}