New Insights into the Use of Cardiac Magnetic Resonance Imaging to Guide Decision-Making in AF Management

Publication date: Available online 12 July 2018Source: Canadian Journal of CardiologyAuthor(s): Tarek Zghaib, Saman NazarianAbstractRecent advances in cardiac magnetic resonance (CMR) imaging acquisition techniques have enabled the visualization of thin atrial myocardium with high temporal and spatial resolution and have the potential to shift atrial fibrillation (AF) management paradigms. Late gadolinium-enhancement (LGE) CMR can non-invasively identify atrial arrhythmogenic scar substrates and has been shown to spatially correlate with low-voltage areas. Immediately post-ablation, a combination of native T1-weighted, LGE, and T2-weighted imaging can assess ablation lesions and localize reversible edema while late post-ablation, LGE-CMR can visualize irreversible fibrosis and detect large ablation gaps. Tissue-tracking on cine-CMR can be used to characterize the impact of ablation and AF-related remodeling upon atrial structure and contractile function. Increased burden of ‘native’ LGE and lower LA function at baseline are associated with worse procedural outcomes and identification of patients with the greatest fibrotic extent may improve patient selection for AF ablation procedures or identify a subset of patients for which PVI alone is unlikely to be beneficial. LAA morphology and LA sphericity index may provide additional prognostic information in AF ablations. A suggested approach for patients with extensive fibrosis includes substrate modification in addition to pu...
Source: Canadian Journal of Cardiology - Category: Cardiology Source Type: research