Left Atrial Structural Remodelling in Non-Valvular Atrial Fibrillation: What Have We Learnt from CMR?

Figures

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  Figure 1. The bidirectional relationship between LA remodeling, atrial cardiomyopathy and atrial failure.

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  Figure 2. LGE-LA of 35.4% (Utah IV) in a persistent AF patient with repetitive ablations. Increased fibrosis at the posterior wall and pulmonary veins. Red demonstrates the presence of fibrosis. AF: atrial fibrillation; LGE-LA- late gadolinium enhancement in the left atrium.

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  Figure 3. Pre-ablation roles of LGE-CMR.* in terms of immediate sinus rhythm restoration and post-procedural arrhythmia recurrences. LA: left atrium; LGE-CMR: late-gadolinium enhancement cardiac magnetic resonance, Utah classes of fibrosis: Utah I: <10%, Utah II: 10%–20%, Utah III: 20%–30%, Utah IV: >30%.

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  Figure 4. The use of CMR imaging in relation to the timing of the index procedure (up, center- pre-ablation, down-left- peri-procedural and down-right- post-ablation). Preablation, the degree of structural remodeling can be assessed through LA volume, sphericity and fibrosis extension and disposition. New techniques are being explored to allow performing full CMR-guided ablation. Post-ablation, CMR is used immediately after the procedure to scan for possible complications and assess early scar formation. Later, CMR can be used to assess the degree of both reverse remodeling and residual fibrosis and describe the ablation lesions gaps. CMR: cardiac magnetic resonance; LA: left atrium; LAA: left atrial appendage; NE: non-enhancing.