The aim of this study was to evaluate the morphology and function of the left atrial appendage (LAA) in different rhythms of paroxysmal atrial fibrillation (PaAF) patients using real-time 3D transesophageal echocardiography. This study included 46 patients with PaAF-24 with PaAF with sinus rhythm (PaAF-S) and 22 with PaAF with fibrillation (PaAF-F)-and 23 healthy volunteers. Real-time 3D transesophageal echocardiography images of the LAA were acquired in all patients. LAA end-diastolic volume increased in PaAF-S and PaAF-F, whereas LAA end-systolic volume increased only in PaAF-F. LAA emptying index, end-diastolic volume and end-systolic volume were strongly negatively correlated. LAA emptying index was positively correlated with percentage changes in LAA area and diameter, as well as flow velocity. The co-occurrence of spontaneous echo contrast and thrombus gradually increased in the PaAF-F group, compared with the PaAF-S group. The morphology and change in function of the LAA in patients with paroxysmal PaAF can be evaluated with superior feasibility and reproducibility using real-time 3D transesophageal echocardiography. Morphologic changes in the LAA appeared earlier than changes in LAA function during the course of PaAF. Spontaneous echo contrast and thrombus co-occurred more often in PaAF-F than in PaAF-S.
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