Abstract

SCAVENIUS AGUILERA, Karina Elizabeth; TORALES SALINAS, Judith María  and  CENTURION, Osmar Antonio. Evaluation of left atrial myocardial fibrosis by cardiac magnetic resonance imaging in atrial fibrillation. Rev. virtual Soc. Parag. Med. Int. [online]. 2024, vol.11, n.1, e11132404.  Epub Sep 02, 2024. ISSN 2312-3893.  https://doi.org/10.18004/rvspmi/2312-3893/2024.e11132404.

Atrial fibrillation is initiated and maintained by triggering factors and the underlying atrial substrate. Therefore, anatomical substrate-modifying ablation techniques are being used. However, none of these complementary strategies have yielded consistent results. Innovations in cardiac magnetic resonance imaging techniques, especially late gadolinium enhancement imaging, have improved our ability to understand better and accurately identify fibrosis in the atrial myocardium of patients with atrial fibrillation. Consideration of atrial fibrosis for the therapeutic management of atrial fibrillation has the potential to significantly improve the understanding and clinical outcomes of atrial fibrillation. However, late gadolinium enhancement cardiac magnetic resonance imaging techniques to assess left atrial fibrosis still require significant experience. Further technical improvements and more generalized imaging methods need to be established.

There is wide individual variation in the extent of left atrial fibrosis in patients with atrial fibrillation. Voltage mapping as a tool to describe fibrotic changes is still under investigation. It depends on several biological and technological variables and still needs to be standardized. The combination of a patient-specific lung and left atrial geometry model with targeted manual processing atrial scar segmentation will certainly be beneficial. All ablation strategies beyond pulmonary vein isolation, including fibrosis-guided ablation, should be confirmed and validated concerning efficacy and safety in prospective multicenter randomized clinical studies.

Keywords : atrial fibrillation; magnetic nuclear resonance; epicardial mapping; fibrosis..

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