Association of Atrial Tissue Fibrosis Identified by Delayed Enhancement MRI and Atrial Fibrillation Catheter Ablation

Marrouche, Nassir F.; Wilber, David J.; Hindricks, Gerhard; Jaı̈s, Pierre; Akoum, Nazem; Marchlinski, Francis E.; Kholmovski, Eugene; Burgon, Nathan; Hu, Nan; Mont, Lluı́s; Deneke, Thomas; Duytschaever, Mattias; Neumann, Thomas; Mansour, Moussa; Mahnkopf, Christian; Herweg, Bengt; Daoud, Emile G.; Wißner, Erik; Bansmann, P. M.; Brachmann, Johannes

doi:10.1001/jama.2014.3

Cited by 1,177 publications

(1,109 citation statements)

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“…poziom aktywności, palenie tytoniu, spożycie alkoholu [169,170]), wskaźników strukturalnej przebudowy serca (np. włóknienie [171][172][173] lub elektrokardiograficzne parametry złożoności AF [174]) bądź podłoża genetycznego. W tabeli 6 przedstawiono taką taksonomię opartą na opinii ekspertów [76,120,175], ale nie ma zbyt wielu dowodów potwierdzających zasadność Właściwe rozróżnienie między napadowym a przetrwałym AF często nie jest możliwe bez dostępu do długoterminowego monitorowania [163].…”

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2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS

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“…Wyniki ablacji przezcewnikowej AF pod względem utrzymywania rytmu zatokowego u poszczególnych pacjentów są trudne do przewidzenia [173,227,713,728]. W celu uzyskania kontroli objawów większość pacjentów wymaga więcej niż jednego zabiegu [713,726,728].…”

Section: Wyniki Ablacji Przezcewnikowej Migotania Przedsionkówunclassified

2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS

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“…415 Using a systematic scoring system for the extent of delayed enhancement, a recentlypublished multicentre study has related the extent of LGE CMR detected fibrosis to the outcome of AF ablation. 416 The risk of recurrent AF increased from 15% for stage I fibrosis (,10% of the atrial wall) to 69% for stage IV fibrosis (≥30% of the atrial wall). The authors suggested that CMR quantification of fibrosis may play a role in the appropriate selection of patients most likely to benefit from AF ablation.…”

Section: Magnetic Resonance Imaging Of the Atriummentioning

confidence: 99%

“…117,167,177,433,452,453 Magnetic resonance imaging techniques attempting to characterize the extent of myocardial fibrosis have demonstrated that this appears to be the strongest independent predictor of AF recurrence after ablation. 416,454 Whether the EHRAS classification has value for informing catheter ablation in human atria remains to be determined.…”

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confidence: 99%

EHRA/HRS/APHRS/SOLAECE expert consensus on atrial cardiomyopathies: definition, characterization, and clinical implication

et al. 2016

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“…Some groups have recommended the use of cardiac MRIdetected left atrial delayed gadolinium enhancement [37][38][39] for the identification of patients in whom AF is likely to recur after catheter ablation 38,40,41 , although an external validation of the feasibility of this technique is needed 42 . The CHARGE AF consortium identified a set of clinical parameters and biomarkers that could be used to predict AF incidence during follow-up, but did not provide information on the most appropriate prevention or therapy approach 43 .…”

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Defining the major health modifiers causing atrial fibrillation: a roadmap to underpin personalized prevention and treatment

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Despite the important advances that have enabled better stroke prevention in atrial fibrillation (AF) and more effective maintenance of sinus rhythm over the past decades, a large unmet need to improve the prevention and treatment of AF remains. Mortality for AF remains at 3.5% per year, and death is often experienced as sudden death or as a result of heart failure 1,2 . Each year, approximately 20% of patients with AF need to be hospitalized 3,4 , and stroke occurs in 1.5% of patients with AF who are receiving anticoagulant drugs 5 . Furthermore, more than half of the patients with AF are symptomatic despite adequate anticoagulation and rate control 4,6 . In view of the projected increase in the incidence and prevalence of AF 7-9 , as well as the substantial burden of death and dis ability that is still associated with this condition 10 , the status quo is unacceptable.Current management of patients with AF comprises treatment of the accompanying cardiovascular conditions, oral anticoagulation, rate control -with medications that slow atrioventricular nodal recovery or, rarely, with atrioventricular nodal ablation -and rhythm-control therapy with antiarrhythmic drugs, electrical cardioversion, catheter ablation or, at times, AF surgery 11,12 . Unfortunately, most of these current approaches are disconnected from our understanding of the major mechanisms that cause AF 1,13,14 1,2,7,19,20 Abstract | Despite remarkable advances in antiarrhythmic drugs, ablation procedures, and stroke-prevention strategies, atrial fibrillation (AF) remains an important cause of death and disability in middle-aged and elderly individuals. Unstructured management of patients with AF sharply contrasts with our detailed, although incomplete, knowledge of the mechanisms that cause AF and its complications. Altered calcium homeostasis, atrial fibrosis and ageing, ion-channel dysfunction, autonomic imbalance, fat-cell infiltration, and oxidative stress, in addition to a susceptible genetic background, contribute to the promotion, maintenance, and progression of AF. However, clinical management of patients with AF is currently guided by stroke risk parameters, AF pattern, and symptoms. In response to this apparent disconnect between the known pathophysiology of AF and clinical management, we propose a roadmap to develop a set of clinical markers that reflect the major causes of AF in patients. Thereby, the insights into the mechanisms causing AF will be transformed into a format that can underpin future personalized strategies to prevent and treat AF, ultimately informing better patient care.230 | APRIL 2016 | VOLUME 13 www.nature.com/nrcardio CONSENSUS STATEMENT © 2 0 1 6 M a c m i l l a n P u b l i s h e r s L i m i t e d . A l l r i g h t s r e s e r v e d .

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Association of Atrial Tissue Fibrosis Identified by Delayed Enhancement MRI and Atrial Fibrillation Catheter Ablation

Abstract: Among patients with AF undergoing catheter ablation, atrial tissue fibrosis estimated by delayed enhancement MRI was independently associated with likelihood of recurrent arrhythmia. The clinical implications of this association warrant further investigation.

Cited by 1,177 publications

References 39 publications

2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS

2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS

EHRA/HRS/APHRS/SOLAECE expert consensus on atrial cardiomyopathies: definition, characterization, and clinical implication

Defining the major health modifiers causing atrial fibrillation: a roadmap to underpin personalized prevention and treatment

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