Int J Heart Fail.  2022 Jan;4(1):42-53. 10.36628/ijhf.2021.0043.

Left Atrial Dysfunction, Fibrosis and the Risk of Thromboembolism in Patients With Paroxysmal and Persistent Atrial Fibrillation

  • 1Division of Cardiology, Department of Internal Medicine, Soonchunhyang University Cheonan Hospital, Cheonan, Korea
  • 2Division of Cardiology, Department of Internal Medicine, Wonju Severance Christian Hospital, Wonju, Korea
  • 3Division of Cardiology, Department of Internal Medicine, Korea University Anam Hospital, Seoul, Korea
  • 4Division of Diagnostic Radiology, Korea University Anam Hospital, Seoul, Korea


Background and Objectives
Left atrial (LA) fibrosis is an important component of the arrhythmogenic substrate and is related to LA dysfunction in patients with atrial fibrillation (AF). However, its relationship with functional changes and the risk of thrombus in patients with paroxysmal AF (PAF) and persistent AF (PeAF) remains unclear.
We included 139 patients with preprocedural cardiac magnetic resonance imaging (CMR) and transesophageal echocardiography (TEE) for the first AF catheter ablation. Spontaneous echo contrast (SEC) and multiple parameters of LA were measured from TEE and CMR. LA fibrosis was evaluated by late gadolinium enhancement of LA (LA-LGE) of CMR.
The presence of SEC was higher in patients with PeAF than in patients with PAF (26.4% vs. 11.9%, p=0.03). The patients with SEC had more enlarged LA size and impaired function of LA and LAA, regardless of AF type. However, the area of LA-LGE was more extensive in patients with SEC in PeAF (27.5±15.9 vs. 20.1±10.3, p=0.033), not in PAF. In PAF, maximal LA volume index was closely related to the presence of SEC with marginal trend toward significance (odd ratio [OR], 1.07; 95% confidence interval [CI], 0.99–1.16; p=0.072). Whereas, a larger area of LA-LGE and lower emptying flux of LA appendage were independently related with SEC (OR, 1.10; 95% CI, 1.0–1.20; p=0.049 and OR, 0.93; 95% CI, 0.86–0.99; p=0.022, respectively) after adjusting related cardiovascular risk factors of SEC Conclusions: In this study, we suggest that the risk of thrombus is provoked by LA enlargement with dysfunction in early-stage AF and by stiffened LA with fibrosis rather than LA size when it becomes PeAF.


Atrial fibrillation; Left atrial function; Spontaneous echo contrast
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