Imaging in atrial fibrillation: A way to assess atrial fibrosis and remodeling to assist decision-making

Lopez-Galvez, Raquel, Rivera-Caravaca, Jose Miguel ORCID: 0000-0003-0492-6241, Roldan, Vanessa, Orenes-Pinero, Esteban, Esteve-Pastor, Maria Asuncion, Lopez-Garcia, Cecilia, Saura, Daniel, Gonzalez, Josefa, Lip, Gregory YH ORCID: 0000-0002-7566-1626 and Marin, Francisco (2023) Imaging in atrial fibrillation: A way to assess atrial fibrosis and remodeling to assist decision-making. AMERICAN HEART JOURNAL, 258. pp. 1-16.

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Abstract

The 2020 ESC atrial fibrillation (AF) guidelines suggest the novel 4S-AF scheme for the characterization of AF. Imaging techniques could be helpful for this objective in everyday clinical practice, and information derived from these techniques reflects basic aspects of the pathophysiology of AF, which may facilitate treatment decision-making, and optimal management of AF patients. The aim of this review is to provide an overview of the mechanisms associated with atrial fibrosis and to describe imaging techniques that may help the management of AF patients in clinical practice. Transthoracic echocardiography is the most common procedure given its versatility, safety, and simplicity. Transesophageal echocardiography provides higher resolution exploration, and speckle tracking echocardiography can provide incremental functional and prognostic information over conventional echocardiographic parameters. In addition, LA deformation imaging, including LA strain and strain rate, are related to the extent of fibrosis. On the other hand, multidetector-row computed tomography and cardiac magnetic resonance provide higher resolution data and more accurate assessment of the dimensions, structure, and spatial relationships of the LA. Imaging is central when deciding on catheter ablation or cardioversion, and helps in selecting those patients who will really benefit from these procedures. Moreover, imaging enhances the understanding of the underlying mechanisms of atrial remodeling and might assists in refining the risk of stroke, which help to select the best medical therapies/interventions. In summary, evaluation of LA enlargement, LA remodeling and fibrosis with imaging techniques adds clinical and prognostic information and should be assessed as a part of routine comprehensive AF evaluation.

Item Type:	Article
Uncontrolled Keywords:	Heart Atria, Humans, Atrial Fibrillation, Fibrosis, Echocardiography, Catheter Ablation, Prognosis
Divisions:	Faculty of Health and Life Sciences Faculty of Health and Life Sciences > Faculty Management Office Faculty of Health and Life Sciences > Institute of Life Courses and Medical Sciences
Depositing User:	Symplectic Admin
Date Deposited:	05 Oct 2023 13:32
Last Modified:	05 Oct 2023 13:32
DOI:	10.1016/j.ahj.2022.12.007
Open Access URL:	https://doi.org/10.1016/j.ahj.2022.12.007
Related URLs:	Author Publisher
URI:	https://livrepository.liverpool.ac.uk/id/eprint/3173466