Key result
MRI or voltage mapping of atrial fibrosis may guide AF anticoagulation, rhythm control, and ablation.
Atrial fibrosis plays a key role in AF and its quantification may guide management strategies, though specific ablation approaches targeting fibrosis require further validation in randomized trials.
May inform AF decisions via fibrosis imaging; leaves open whether targeted ablation improves outcomes.
Fibrosis plays a fundamental role in the initiation and maintenance of AF, mainly due to enhanced automaticity and anisotropy-related re-entry. The identification and quantification of atrial fibrosis is achieved either preprocedurally by late gadolinium enhancement MRI or intraprocedurally using electroanatomic voltage mapping. The presence and extent of left atrial fibrosis among AF patients may influence relevant decision making regarding the need for anticoagulation, the adoption of rate versus rhythm control and mainly the type of ablation strategy that will be followed during interventional treatment. Several types of individualised substrate modifications targeting atrial fibrotic areas have been proposed, although their impact on patient outcome needs to be further investigated in adequately powered prospective randomised controlled clinical trials.
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Tzeis et al. (2019) conducted a review in Atrial Fibrillation. The identification and quantification of atrial fibrosis using MRI or voltage mapping may guide decision-making for anticoagulation, rate versus rhythm control, and ablation strategy in AF patients.
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