Author + information
- Received April 29, 2017
- Revision received July 7, 2017
- Accepted July 13, 2017
- Published online August 21, 2017.
- aComprehensive Arrhythmia and Research Management (CARMA) Center, University of Utah School of Medicine, Salt Lake City, Utah
- bDepartment of Medicine I, Klinikum Grosshadern, University of Munich, Munich, Germany
- cGerman Cardiovascular Research Center (DZHK), partner site Munich Heart Alliance, Munich, Germany
- dUCAIR, Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, Utah
- ↵∗Address for correspondence:
Dr. Nassir Marrouche, Comprehensive Arrhythmia Research and Management (CARMA) Center, University of Utah, 30 North 1900 East, Room 4A100, Salt Lake City, Utah 84132.
Recently, studies using late gadolinium enhancement (LGE) magnetic resonance imaging (MRI) to identify structural changes of atrial tissue have contributed significantly to understanding the pathophysiology and progression of atrial fibrillation (AF). Moreover, imaging of atrial fibrosis using MRI has evolved to be a tool to improve clinical outcome of AF ablation procedures by allowing a patient-specific individualized management approach. LGE-MRI has been shown to predict AF ablation outcome based on pre-procedural imaging to define the extent of atrial fibrosis. The results of the ongoing DECAAF II (Delayed-Enhancement MRI Determinant of Successful Radiofrequency Catheter Ablation of Atrial Fibrillation) trial might extend ablation strategies from pulmonary vein isolation alone to a substrate-based approach. Furthermore, an improved understanding of the underlying mechanisms of atrial structural remodeling is crucial in order to reduce the occurrence of AF-associated complications (e.g., ischemic stroke and heart failure). This review article provides current methodology of atrial fibrosis imaging using LGE-MRI and delineates actual clinical implications and future directions for this imaging approach.
Dr. Kholmovski owns stock in and has been a consultant for Marrek Inc. Dr. Marrouche has ownership interest in Marrek, Inc. and Cardiac Designs; has received research funding from Biosense Webster, Medtronic, St. Jude Medical, Boston Scientific; and has received consulting fees from Biotronik, Preventice, Biosense Webster, and Abbott. Dr. Siebermair has reported that he has no relationships relevant to the contents of this paper to disclose.
All authors attest they are in compliance with human studies committees and animal welfare regulations of the authors’ institutions and Food and Drug Administration guidelines, including patient consent where appropriate. For more information, visit the JACC: Clinical Electrophysiology author instructions page.
- Received April 29, 2017.
- Revision received July 7, 2017.
- Accepted July 13, 2017.
- 2017 American College of Cardiology Foundation
- Graphical abstract
- Use of LGE MRI for Imaging of Atrial Fibrosis
- Upstream Approaches for AF Treatment
- Predicting Clinical Outcome With Respect to Stroke and Heart Failure
- Selecting Appropriate Candidates for Treatment (Recurrence Post-Ablation)
- Fibrosis as an Ablation Target to Improve Outcome