Developments in imaging tools for AF

Although echocardiography is still the most widely applied tool to stratify patients in clinical practice, late gadolinium enhancement (LGE)-MRI and electrocardiographic imaging (ECGi) are promising tools that may contribute to a personalised approach in atrial fibrillation (AF) management.

“The severity of atrial cardiomyopathy is related to the success of rhythm control therapies,” said Prof. Lluis Mont (University of Barcelona, Spain) [1]. The more precise the extent of atrial cardiomyopathy in patients can be measured, the better the selection of which patients should receive rhythm control therapy and which patients should receive rate control therapy. Prof. Mont discussed the developments in imaging tools that can be applied to discriminate between patients with AF.

Echocardiography

Everything starts by obtaining a good echo. Measuring the left atrium size with echocardiographic imaging is a simple, reproducible, and robust predictor for AF recurrence and stroke. Evidence suggests that more advanced echocardiographic techniques can reveal functional deficits of the atrium [2].

LGE-MRI

Although evidence has been presented on the measurement of atrial cardiomyopathy via LGE-MRI, this tool is still in progress. LGE-MRI images of fibrosis have been shown to correlate with low-voltage areas of the left atrium and the degree of fibrosis on LGE-MRI has been associated with AF recurrence [3,4]. However, the randomised-controlled ALICIA trial (NCT02698631) and DECAAF II trial (NCT02529319) did not show a clinical benefit of MRI-guided pulmonary vein isolation (PVI) versus conventional PVI. LGE-MRI has not yet demonstrated to improve outcomes through MRI-guided ablation but may help in the selection of suitable patients for AF ablation.

Electrocardiographic imaging

ECGi is a non-invasive tool that can measure the activation and local conduction velocities of the heart. Also, ECGi allows for single beat mapping to detect individual AF patterns. ECGi-derived activation times have shown useful in diagnosing atrial cardiomyopathy and are predictive of AF recurrence after PVI [5]. "Currently, our study group is linking MRI fibrosis to conduction velocities to see whether accurate prognosis and personalised ablation decisions can be made based on this imaging tool.”

“All in all, imaged-based phenotyping has great potential to move us towards personalised AF management,” concluded Prof. Mont.

1. Mont L. Imaging tools for atrial phenotyping to tailor rate vs. rhythm control. Precision medicine approach to AF, EHRA 2022, 3–5 April, Copenhagen, Denmark.
2. Papadopoulos CH, et al. Hellenic J Cardiol. 2018;59(3):140‒149.
3. Oakes RS, et al. Circulation. 2009;119(13):1758‒1767.
4. Marrouche NF, et al. JAMA. 2014;311(5):498‒506.
5. Eichenlaub M, et al. Europace. 2021;23(12):2010‒2019.

Copyright ©2022 Medicom Medical Publishers



Posted on 31 May, 202213 June, 2022