A Novel Finding: Atrial Substrate Properties and Long-Term Results of Catheter Ablation in Chronic Atrial Fibrillation Patients with Left Atrial Spontaneous Echo Contrast

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Background: The atrial substrate in chronic atrial fibrillation (AF) patients with left atrial spontaneous echo contrast (LASEC) has not been previously reported. Methods: Of 36 consecutive patients with chronic AF who received stepwise ablation approach, 18 patients with an LASEC (group I) were compared with 18 age-gender-left atrial volume matched patients without an LASEC (group II). The atrial substrate properties including atrial voltage, dominant frequency (DF), and complex fractionated electrograms (CFEs) in the bi-atrial were evaluated. Result: The left atrial voltage (1.0±0.6 vs. 1.6±0.7 mV, p=0.04), total activation time (119±20 vs. 103±13 msec, p<0.001) and DF (7.3±1.3 vs. 6.6±0.7 Hz, p<0.001) differed between group I and group II, respectively. The bi-atrial CFEs did not differs between group. After a mean follow-up of 30±13 month, there were significant differences in the anti-arrhythmic drugs (1.1±0.3 vs. 0.7±0.5, p=0.02) needed after ablation, and recurrence as persistent AF (92% vs. 50%, p=0.03) between group I and group II, respectively. After multiple procedures, there were more group II patients that remained in SR, when compared with group I (78% vs. 44%, p=0.04). Conclusion: There was a poorer atrial substrate, lesser SR maintenance after catheter ablation and need for more anti-arrhythmic drugs in the chronic AF patients with LASEC when compared with those without LASEC.