Magnetic resonance imaging of atrial fibrosis: redefining atrial fibrillation to a syndrome

Atrial fibrillation (AF) is the most common sustained arrhythmia and its treatment continues to be a challenge. Recently, delayed enhancement (DE)-MRI was introduced in the diagnosis and treatment of AF by the assessment of atrial fibrosis, which is considered the hallmark of the arrhythmogenic subs...

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Bibliographic Details
Published in:European heart journal 2017-01, Vol.38 (1), p.14-19
Main Authors: Gal, Pim, Marrouche, Nassir F
Format: Article
Language:English
Subjects:
Adult
Aged
Aged, 80 and over
Atrial Fibrillation - pathology
Atrial Fibrillation - surgery
Cardiomyopathies - pathology
Catheter Ablation - methods
Cicatrix - pathology
Disease Progression
Fibrosis - pathology
Heart Atria - pathology
Humans
Magnetic Resonance Angiography - methods
Middle Aged
Pulmonary Veins - pathology
Stroke - pathology
Syndrome
Treatment Outcome
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Summary:Atrial fibrillation (AF) is the most common sustained arrhythmia and its treatment continues to be a challenge. Recently, delayed enhancement (DE)-MRI was introduced in the diagnosis and treatment of AF by the assessment of atrial fibrosis, which is considered the hallmark of the arrhythmogenic substrate in AF. Atrial fibrosis was reported to be an independent predictor of arrhythmia recurrences. Post-ablation DE-MRI allows for assessment of the total scar burden, complete encirclement of pulmonary veins, and the assessment of residual fibrosis, which were all reported to be strong predictors of arrhythmia recurrences post-ablation. Current pathophysiological perspectives for AF are heavily based on the adagium AF begets AF. However, several recent observations, such as atrial fibrosis being present in non-AF patients, do introduce a new pathophysiological perspective for AF. Potentially, atrial fibrosis is a disease process that triggers the initiation and maintenance of the syndrome AF.
ISSN:0195-668X
1522-9645
DOI:10.1093/eurheartj/ehv514