The Spatial Distribution of Late Gadolinium Enhancement of Left Atrial Magnetic Resonance Imaging in Patients With Atrial Fibrillation

Higuchi, Koji; Cates, Joshua; Gardner, Gregory; Morris, Alan; Burgon, Nathan; Akoum, Nazem; Marrouche, Nassir F.

doi:10.1016/j.jacep.2017.07.016

Cited by 44 publications

(33 citation statements)

References 25 publications

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“…Interestingly, fibrosis disposition is inhomogeneous with its different locations being linked to arrhythmia recurrences. The posterior wall and left inferior pulmonary vein are preferentially affected, especially in persistent AF patients [32,33]. This is in accordance with histological studies [7].…”

Section: Pre-ablation Fibrosis Assessmentsupporting

confidence: 89%

“…This offers a patient-tailored approach and several authors are researching the topic. Inhomogeneous LA fibrosis may call for different ablation strategies, such as posterior wall debulking or ablation of low voltage areas [32]. Figure 3 summarizes the pre-ablation roles of LGE-CMR in relation to both thromboembolic risk and procedural success rate.…”

Section: Pre-ablation Fibrosis Assessmentmentioning

confidence: 99%

See 1 more Smart Citation

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

et al. 2020

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Left atrial structural, functional and electrical remodelling are linked to atrial fibrillation (AF) pathophysiology and mirror the phrase “AF begets AF”. A structurally remodelled left atrium (LA) is fibrotic, dysfunctional and enlarged. Fibrosis is the hallmark of LA structural remodelling and is associated with increased risk of stroke, heart failure development and/or progression and poorer catheter ablation outcomes with increased recurrence rates. Moreover, increased atrial fibrosis has been associated with higher rates of stroke even in sinus-rhythm individuals. As such, properly assessing the fibrotic atrial cardiomyopathy in AF patients becomes necessary. In this respect, late-gadolinium enhancement cardiac magnetic resonance (LGE-CMR) imaging is the gold standard in imaging myocardial fibrosis. LA structural remodelling extension offers both diagnostic and prognostic information and influences therapeutic choices. LGE-CMR scans can be used before the procedure to better select candidates and to aid in choosing the ablation technique, during the procedure (full CMR-guided ablations) and after the ablation (to assess the ablation scar). This review focuses on imaging several LA structural remodelling CMR parameters, including size, shape and fibrosis (both extension and architecture) and their impact on procedure outcomes, recurrence risk, as well as their utility in relation to the index procedure timing.

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Section: Pre-ablation Fibrosis Assessmentsupporting

confidence: 89%

Section: Pre-ablation Fibrosis Assessmentmentioning

confidence: 99%

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

et al. 2020

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“…Late gadolinium-enhanced magnetic resonance imaging (LGE-MRI) is widely used to study the extent and distribution of cardiac fibrosis/scarring [2,8]. Clinical studies in AF patients using LGE-MRI suggest that the extent and distribution of atrial fibrosis (Utah stages I-IV) are reliable predictors of catheter ablation success rate and can be used for patient stratification for medical management [9,10]. A large ongoing clinical trial, LGE-MRI Guided Ablation vs.…”

Section: Introductionmentioning

confidence: 99%

“…Similar techniques have also been proposed and further improved upon for segmenting the LA from LGE-MRIs in studies by Veni et al [14], Zhu et al [15] and Tao et al [16]. Despite these recent efforts, most of the existing structural analysis studies, especially those that utilize clinical LGE-MRIs, are still based on laborintensive and error-prone manual segmentation approaches [9,10,12]. This is mainly due to the limitations of current automated methodologies requiring supporting information which are often not available, such as shape priors for initialization [15,17] or additional magnetic resonance angiography (MRA) sequences to aid the segmentation process [16].…”

Section: Introductionmentioning

confidence: 99%

Fully Automatic Left Atrium Segmentation From Late Gadolinium Enhanced Magnetic Resonance Imaging Using a Dual Fully Convolutional Neural Network

Xiong

Fedorov

et al. 2019

IEEE Trans. Med. Imaging

122

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Atrial fibrillation (AF) is the most prevalent form of cardiac arrhythmia. Current treatments for AF remain suboptimal due to a lack of understanding of the underlying atrial structures that directly sustain AF. Existing approaches for analyzing atrial structures in 3D, especially from late gadolinium-enhanced (LGE)-MRIs, rely heavily on manual segmentation methods which are extremely labor-intensive and prone to errors. As a result, a robust and automated method for analyzing atrial structures in 3D is of high interest. We have therefore developed AtriaNet, a 16layer convolutional neural network (CNN), on 154 3D LGE-MRIs with a spatial resolution of 0.625 mm × 0.625 mm × 1.25 mm from patients with AF, to automatically segment the left atrial (LA) epicardium and endocardium. AtriaNet consists of a multi-scaled, dual pathway architecture that captures both the local atrial tissue geometry, and the global positional information of LA using 13 successive convolutions, and 3 further convolutions for merging. By utilizing computationally efficient batch prediction, AtriaNet was able to successfully process each 3D LGE-MRI within one minute. Furthermore, benchmarking experiments showed that AtriaNet outperformed state-of-the-art CNNs, with a DICE score of 0.940 and 0.942 for the LA epicardium and endocardium respectively, and an inter-patient variance of <0.001. The estimated LA diameter and volume computed from the automatic segmentations were accurate to within 1.59 mm and 4.01 cm³ of the ground truths. Our proposed CNN was tested on the largest known dataset for LA segmentation, and to the best of our knowledge, it is the most robust approach that has ever been developed for segmenting LGE-MRIs. The increased accuracy of atrial reconstruction and analysis could potentially improve the understanding and treatment of AF.

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“…Nagymére-tű fibroticus régiók, továbbá Utah IV. stádium esetén a sikeres ablatio esélye csekélyebb [2,5,32].…”

Section: A Pitvari Fibrosis Mértékének Jelentősége a Katéterablatio Sunclassified

Új felismerések a pitvarfibrilláció genezisében és fenntartásában: az egyénre szabott kezelés lehetőségei

2018

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A pitvarfibrilláció prevalenciája a felnőttkorosztályban körülbelül három százalék. A ritmuskontroll céljából alkalmazott katéterablatiós terápia alapját jelenleg a pulmonalis vénák izolációja képezi, amelynek egyéves sikeraránya azonban többszöri beavatkozással sem emelhető 70% fölé. A beavatkozás hosszú távú eredményességét a pitvarokban bekövetkező elektromos és strukturális remodelláció korlátozza, amely az arrhythmia tartós fennmaradásához vezet. Az epicardialis zsírszöveti akkumuláció, a pitvari fibrosis, az autonóm idegrendszeri hatások, valamint a különféle arrhythmogen gócok lehetséges szerepét számos tanulmány elemezte. A pitvari epicardialis zsírszövet mennyisége, gyulladás indukálta fibroticus átalakulása és a myocardium zsíros infiltrációja, például obesitas esetén, pitvarfibrilláció fellépésére hajlamosít. Az autonóm szabályozás egyensúlyának megváltozása, például rendszeres sporttevékenység hatására, a triggerelt aktivitás fokozódása, valamint a pitvari refrakter periódus csökkenése révén indukálhat ritmuszavart. Hatékony terápia a lehetséges arrhythmogen trigger és szubsztrátmechanizmusok egyénre szabott komplex befolyásolása által valósulhat meg. A fibroticus folyamatok a renin-angiotenzin-aldoszteron rendszer gátlása révén lassíthatók. A neuromodulációs lehetőségek magukban foglalják a renalis denervációt, illetve a ganglionablatiót, és az antikoaguláns terápia pitvari remodellációt gátló hatásáról is ismertek adatok. A katéterablatiós beavatkozások lehetséges új irányait a jobb és bal pitvari lineáris laesiók alkalmazása, a heges területek homogenizálása mellett a komplex frakcionált pitvari elektrogramok, rotorok és az ectopiás fókuszok ablatiója képezik. Mindezek mellett kiemelt fontosságú a fennálló rizikófaktorok, úgymint obesitas, hyperlipidaemia, hypertonia, diabetes mellitus és obstruktív alvá-si apnoe hosszú távú, tervezett kezelése. Orv Hetil. 2018; 159(28): 1135-1145.Kulcsszavak: pitvarfibrilláció, pitvari remodelláció, zsírszövet, autonóm idegrendszer, egyénre szabott kezelés Novel mechanisms in the initiation and maintenance of atrial fibrillation: tailored individual treatmentAtrial fibrillation affects approximately three percent of the adults. Ablation strategies targeting the isolation of the pulmonary veins are the up-to-date cornerstones for atrial fibrillation ablations. However, a one-year success rate of repeated interventions is not more than 70%. Long-term efficacy of catheter ablation is presumably limited by electrical and structural remodeling of the atria, which results in a progressive increase in the duration of atrial fibrillation to become sustained. The potential pathophysiological importance of the epicardial adipose tissue, atrial fibrosis, autonomic nervous system and arrhythmogenic foci are documented by several studies. Increased volume, inflammation induced transformation to fibrosis and myocardial infiltration of atrial subepicardial fat in obese patients result in higher risk of atrial fibrillation development. Changes in atrial autonomic innervation und...

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The Spatial Distribution of Late Gadolinium Enhancement of Left Atrial Magnetic Resonance Imaging in Patients With Atrial Fibrillation

Abstract: LGE in the LA was heterogeneously distributed. LGE was highly distributed in the inferior left PV antrum near the posterior wall side, and spread on the posterior and anterior wall with AF progression.

Cited by 44 publications

References 25 publications

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

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

Fully Automatic Left Atrium Segmentation From Late Gadolinium Enhanced Magnetic Resonance Imaging Using a Dual Fully Convolutional Neural Network

Új felismerések a pitvarfibrilláció genezisében és fenntartásában: az egyénre szabott kezelés lehetőségei

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