The atrial substrate has been shown to play a role in the initiation of atrial fibrillation
(AF), and the subsequent remodeling that occurs promotes the continuation of the arrhythmia.
The result of this cyclic process is believed to be fibrosis of atrial tissue. Part
of the atrial substrate includes atrial interstitial fibrosis, which has been shown
to cause abnormal conduction leading to a substrate for AF.
1
,2
Additionally, these regions of fibrosis can lead to decreased conduction velocities
(CVs), which can lead to the formation of reentrant atrial tachyarrhythmias (ATs).
3
The clinical significance of this fibrosis is illustrated by AF therapy, where patients
with increased left atrial fibrosis are more likely to have recurrence of AF after
ablation.
4
,5
Thus, a clinical means to evaluate and characterize the severity of fibrosis would
be a useful diagnostic modality for AF therapy. Delayed-enhancement magnetic resonance
imaging has been validated to assess fibrotic tissue
6
; however, limitations still remain, including lack of sufficient resolution, possible
inability to differentiate atrial fibrosis subtypes, and lack of standardization for
image postprocessing and threshold values.
7
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References
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- Implications of inflammation and fibrosis in atrial fibrillation pathophysiology.Card Electrophysiol Clin. 2021; 13: 25-35
- High-resolution mapping of reentrant atrial tachycardias: relevance of low bipolar voltage.Heart Rhythm. 2023; 20: 430-437
- Scar-based catheter ablation for persistent atrial fibrillation.Curr Opin Cardiol. 2017; 32: 1-9
- Effect of MRI-guided fibrosis ablation vs conventional catheter ablation on atrial arrhythmia recurrence in patients with persistent atrial fibrillation: the DECAAF II randomized clinical trial.JAMA. 2022; 327: 2296-2305
- MRI-guided fibrosis ablation vs conventional catheter ablation for patients with persistent atrial fibrillation—reply.JAMA. 2022; 328: 1644-1645
- MRI-guided fibrosis ablation vs conventional catheter ablation for patients with persistent atrial fibrillation.JAMA. 2022; 328: 1643-1644
- Left atrial voltage mapping: defining and targeting the atrial fibrillation substrate.J Interv Card Electrophysiol. 2019; 56: 213-227
- Bipolar voltage amplitude: what does it really mean?.Heart Rhythm. 2016; 13: 326-327
- Fibrosis and cardiac arrhythmias.J Cardiovasc Pharmacol. 2011; 57: 630-638
- Left atrial scarring and conduction velocity dynamics: rate dependent conduction slowing predicts sites of localized reentrant atrial tachycardias.Int J Cardiol. 2019; 278: 114-119
Article info
Publication history
Published online: December 01, 2022
Footnotes
Funding Sources: The authors have no funding sources to disclose.
Disclosures: The authors have no conflicts of interest to disclose.
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