Atrial fibrillation (AF) patients can be referred to cardiac magnetic resonance imaging (MRI) for an accurate assessment of cardiac function and left atrial structure. Cardiac MRI is the gold standard for the quantification of heart volumes and allows the noninvasive tissue characterization of the heart. In addition, advanced flow assessment can be achieved using 4D-flow MRI to elegantly depict the hemodynamic efficiency of the left atrium (LA) and left ventricle (LV) throughout the cardiac cycle. Patients with AF may have occult LV disease and thrombus formation. Biomarkers based on 4D-flow MRI may unmask the presence of LA/LV disease by quantifying 3D stasis, flow distribution, and vortex formation. These biomarkers have proved to characterize AF stages, to complement standard risk scores, and bring new insights on heart hemodynamic performance. This chapter aims to present a standard cardiac MRI protocol for atrial fibrillation and the innovative usefulness of advanced flow imaging in clinical settings.
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