The role of non-invasive assessment of left atrial fibrosis and improved strategies for the treatment of patients with atrial fibrillation

Kirilova V.S.; Stukalova O.V.; Maykov E.B.

doi:https://doi.org/10.17116/Cardiobulletin20221703114

Close metadata

Recommended articles:

Fibrin monomer in diagnosis of cardiovascular diseases. Russian Cardiology Bulletin. 2024;(4-2):113-120

Phase II clinical trial of refralon tablets in patients with persistent atrial fibrillation and atrial flutter. The structure and plan of the study. Russian Cardiology Bulletin. 2024;(4-2):182-187

Refralon for drug-induced cardioversion of atrial fibrillation in patients with coronary artery disease. Russian Cardiology Bulletin. 2024;(4-2):188-196

Frailty in patients with atrial fibrillation: diagnosis, management, prevention and influence on prognosis. Russian Cardiology Bulletin. 2025;(1):5-12

Obstructive sleep apnea syndrome as a predictor of atrial fibrillation. Russian Journal of Preventive Medicine. 2025;(1):109-114

Immediate results of mitral and aortic valve replacement with simultaneous Cox-Maze IV procedure. Russian Journal of Cardiology and Cardiovascular Surgery. 2025;(1):28-33

The Relationship of obstructive sleep apnea with paroxysmal atrial fibrillation in women suffered coronary heart disease and arterial hypertension. Russian Journal of Preventive Medicine. 2025;(2):61-66

Pathogenesis of fibrosis development in ovarian endometriosis. Russian Journal of Archive of Pathology. 2025;(2):73-78

The CryoMaze procedure for non-paroxysmal atrial fibrillation in patients undergoing heart valve surgery. Pirogov Russian Journal of Surgery. 2025;(5):65-71

Liver involvement in Gaucher disease in children: A literature review and clinical observations. Russian Journal of Evidence-Based Gastroenterology. 2025;(2):78-93

Abstract:

Atrial fibrillation is the most common heart rhythm disorder in humans. This heart rhythm disturbance is one of the main causes of stroke, heart failure and sudden death in the world. Left atrial myocardium remodeling is essential in development and persistence of atrial fibrillation. Atrial fibrosis is one of the key pathogenic factors of remodeling process. Non-invasive assessment of atrial and ventricular fibrosis facilitates selection of optimal treatment strategies and catheter ablation.

Keywords:

atrial fibrillation

left atrial remodeling

fibrosis

catheter ablation

contrast-delayed magnetic resonance imaging

Authors:

Kirilova V.S.

Chazov National Medical Research Center of Cardiology

Stukalova O.V.

National Medical Research Center of Cardiology

Maykov E.B.

Chazov National Medical Research Center of Cardiology

Received:

01.07.2022

Accepted:

08.07.2022

Close metadata

References:

Benjamin EJ, Muntner P, Alonso A, Bittencourt MS, Callaway CW, Carson AP, Chamberlain AM, Chang AR, Cheng S, Das SR, Delling FN, Djousse L, Elkind M-SV, Ferguson JF, Fornage M, Jordan LC, Khan SS, Kissela BM, Knutson KL, Kwan TW, Lackland DT, Lewis TT, Lichtman JH, Longenecker CT, Loop MS, Lutsey PL, Martin SS, Matsushita K, Moran AE, Mussolino ME, O’Flaherty M, Pandey A, Perak AM, Rosamond WD, Roth GA, Sampson U-KA, Satou GM, Schroeder EB, Shah SH, Spartano NL, Stokes A, Tirschwell DL, Tsao CW, Turakhia MP, VanWagner LB, Wilkins JT, Wong SS, Virani SS and On behalf of the American Heart Association Council on Epidemiology and Prevention Statistics Committee and Stroke Statistics Subcommittee. Heart Disease and Stroke Statistics — 2019 Update: A Report From the American Heart Association. Circulation. 2019;139(10):56-528. https://doi.org/10.1161/CIR.0000000000000659
Waldmann V, Jouven X, Narayanan K, Piot O, Chugh SS, Albert CM, Marijon E. Association between atrial fibrillation and sudden cardiac death: pathophysiological and epidemiological insights. Circulation Research. 2020;127(2):301-309. https://doi.org/10.1161/CIRCRESAHA.120.316756
Essa H, Hill AM, Lip GY. Atrial Fibrillation and Stroke. Cardiac Electrophysiology Clinics. 2021;13(1):243-255. https://doi.org/10.1016/j.ccep.2020.11.003
Verdecchia P, Angeli F, Reboldi G. Hypertension and atrial fibrillation: doubts and certainties from basic and clinical studies. Circulation Research. 2018;122(2):352-368. https://doi.org/10.1161/CIRCRESAHA.117.311402
Aune D, Feng T, Schlesinger S, Janszky I, Norat T, Riboli E. Diabetes mellitus, blood glucose and the risk of atrial fibrillation: a systematic review and meta-analysis of cohort studies. Journal of Diabetes and its Complications. 2018;32(5):501-511. https://doi.org/10.1016/j.jdiacomp.2018.02.004
Tomasdottir M, Held C, Hadziosmanovic N, Westerbergh J, Lindbäck J, Aylward PE, Budaj A, Cannon CP, Engdahl J, Granger CB, Koenig W, Manolis AJ, Oldgren J, Stewart RAH, Svennberg E, Vinereanu D, White HD, Siegbahn A, Wallentin L, Hijazi Z. Risk markers of incident atrial fibrillation in patients with coronary heart disease. American Heart Journal. 2021;233:92-101. https://doi.org/10.1016/j.ahj.2020.12.016
Odutayo A, Wong CX, Hsiao A J, Hopewell S, Altman DG, Emdin CA. Atrial fibrillation and risks of cardiovascular disease, renal disease, and death: systematic review and meta-analysis. British Medical Journal. 2016;354:i4482. https://doi.org/10.1136/bmj.i4482
Cadby G, McArdle N, Briffa T, Hillman DR, Simpson L, Knuiman M, Hung J. Severity of OSA is an independent predictor of incident atrial fibrillation hospitalization in a large sleep-clinic cohort. Chest. 2015;148(4):945-952. https://doi.org/10.1378/chest.15-0229
Allan V, Honarbakhsh S, Casas JP, Wallace J, Hunter R, Schilling R, Perel P, Morley K, Banerjee A, Hemingway H. Are cardiovascular risk factors also associated with the incidence of atrial fibrillation? Journal of Thrombosis and Haemostasis. 2017;117(5):837-850. https://doi.org/10.1160/TH16-11-0825
Feghaly J, Zakka P, London B, MacRae CA, Refaat MM. Genetics of atrial fibrillation. Journal of the American Heart Association. 2018;7(20):e009884. https://doi.org/10.1161/JAHA.118.009884
Sohns C, Marrouche NF. Atrial fibrillation and cardiac fibrosis. European Heart Journal. 2020;41(10):1123-1131. https://doi.org/10.1093/eurheartj/ehz786
Goette A, Kalman JM, Aguinaga L, Akar J, Cabrera JA, Chen SA, Chugh SS, Corradi D, D’Avila A, Dobrev D, Fenelon G, Gonzalez M, Hatem SN, Helm R, Hindricks G, Ho SY, Hoit B, Jalife J, Kim YH, Lip GY, Ma CS, Marcus GM, Murray K, Nogami A, Sanders P, Uribe W, Van Wagoner DR, Nattel S. EHRA/HRS/APHRS/SOLAECE expert consensus on Atrial cardiomyopathies: Definition, characterisation, and clinical implication. Journal of Arrhythmia. 2016;32:247-278. https://doi.org/10.1093/europace/euw161
Guichard JB, Nattel S. Atrial cardiomyopathy: a useful notion in cardiac disease management or a passing fad? Journal of the American College of Cardiology. 2017;70(6):756-765. https://doi.org/10.1016/j.jacc.2017.06.033
Bisbal F, Baranchuk A, Braunwald E, Bayés de Luna A, Bayés-Genís A Atrial Failure as a Clinical Entity: JACC Review Topic of the Week. Journal of the American College of Cardiology. 2020;75(2):222-232. https://doi.org/10.1016/j.jacc.2019.11.013
Hoit BD. Left atrial remodeling: more than just left atrial enlargement. Circulation: Cardiovascular Imaging. 2017;10(2):e006036. https://doi.org/10.1161/CIRCIMAGING.117.006036
Tzeis S, Asvestas D, Vardas P. Atrial fibrosis: translational considerations for the management of AF patients. Arrhythmia & Electrophysiology Review. 2019;8(1):37. https://doi.org/10.15420/aer.2018.79.3
Habibi M, Lima JA, Khurram IM, Zimmerman SL, Zipunnikov V, Fukumoto K, Spragg D, Ashikaga H, Rickard J, Marine JE, Calkins H, Nazarian S. Association of left atrial function and left atrial enhancement in patients with atrial fibrillation: cardiac magnetic resonance study. Circulation: Cardiovascular Imaging. 2015;8(2):e002769. https://doi.org/10.1161/CIRCIMAGING.114.002769
Sygitowicz G, Maciejak-Jastrzębska A, Sitkiewicz D. A Review of the Molecular Mechanisms Underlying Cardiac Fibrosis and Atrial Fibrillation. Journal of Clinical Medicine. 2021;10(19):4430. https://doi.org/10.3390/jcm10194430
Jadidi A, Müller-Edenborn B, Chen J. The duration of the amplified sinus-P-wave identifies presence of left atrial low voltage substrate and predicts outcome after pulmonary vein isolation in patients with persistent atrial fibrillation. JACC: Clinical Electrophysiology. 2018;4(4):531-543. https://doi.org/10.1016/j.jacep.2017.12.001
German DM, Kabir M M, Dewland T A, Henrikson CA, Tereshchenko LG. Atrial fibrillation predictors: importance of the electrocardiogram. Annals of Noninvasive Electrocardiology. 2016;21(1):20-29. https://doi.org/10.1111/anec.12321
Cameli M, Mandoli GE, Loiacono F, Sparla S, Iardino E, Mondillo S. Left atrial strain: a useful index in atrial fibrillation. International Journal of Cardiology. 2016;220:208-213. https://doi.org/10.1016/j.ijcard.2016.06.197
Tan TC, Koutsogeorgis ΙD, Grapsa J, Papadopoulos C, Katsivas A, Nihoyannopoulos P. Left atrium and the imaging of atrial fibrosis: catch it if you can! European Journal of Clinical Investigation. 2014;44(9):872-881. https://doi.org/10.1111/eci.12305
Pilichowska‐Paszkiet E, Baran J, Sygitowicz G, Sikorska A, Stec S, Kułakowski P, Zaborska B. Noninvasive assessment of left atrial fibrosis. Correlation between echocardiography, biomarkers, and electroanatomical mapping. Echocardiography. 2018;35(9):1326-1334. https://doi.org/10.1111/echo.14043
Laish‐Farkash A, Perelshtein Brezinov O, Valdman A, Tam D, Rahkovich M, Kogan Y, Marincheva G. Evaluation of left atrial remodeling by 2D‐speckle‐tracking echocardiography versus by high‐density voltage mapping in patients with atrial fibrillation. Journal of Cardiovascular Electrophysiology. 2021;32(2):305-315. https://doi.org/10.1111/jce.14837
De Sensi F, Penela D, Soto-Iglesias D, Berruezo A, Limbruno U. Imaging Techniques for the Study of Fibrosis in Atrial Fibrillation Ablation: From Molecular Mechanisms to Therapeutical Perspectives. Journal of Clinical Medicine. 2021;10(11):2277. https://doi.org/10.3390/jcm10112277
Marrouche NF, Greene T, Dean JM, Kholmovski EG, Boer LM, Mansour M, Calkins H, Marchlinski F, Wilber D, Hindricks G, Mahnkopf C, Jais P, Sanders P, Brachmann J, Bax J, Dagher L, Wazni O, Akoum N. Efficacy of LGE‐MRI‐guided fibrosis ablation versus conventional catheter ablation of atrial fibrillation: The DECAAF II trial: Study design. Journal of Cardiovascular Electrophysiology. 2021;32(4):916-924. https://doi.org/10.1111/jce.14957
Flett AS, Hasleton J, Cook C, Hausenloy D, Quarta G, Ariti C, Muthurangu V, Moon JC. Evaluation of techniques for the quantification of myocardial scar of differing etiology using cardiac magnetic resonance. JACC: Cardiovascular Imaging. 2011;4(2):150-156. https://doi.org/10.1016/j.jcmg.2010.11.015
Croisille P, Revel D, Saeed M. Contrast agents and cardiac MR imaging of myocardial ischemia: from bench to bedside. European Radiology. 2006;16(9):1951-1963. https://doi.org/10.1007/s00330-006-0244-z
Stukalova OV, Aparina OP, Parkhomenko DV, Mironova NA, Golitsyn SP, Ternovoj SK. Invention patent RU 2549825 C1, 27.04.2015. (In Russ.).
Stukalova OV, Aparina OP, Parkhomenko DV, Ternovoy SK. Evaluation of left atrial structural changes of myocardium in patients with atrial fibrillation using late gadolinium enhancement magnetic resonance imaging. Russian Electronic Journal of Radiology. 2014;4(4):7-15. (In Russ.).
Gal P, Marrouche NF. Magnetic resonance imaging of atrial fibrosis: redefining atrial fibrillation to a syndrome. European Heart Journal. 2017;38(1):14-19. https://doi.org/10.1093/eurheartj/ehv514
Oakes RS, Badger TJ, Kholmovski EG, Akoum N, Burgon NS, Fish EN, Blauer JJ, Rao SN, DiBella EV, Segerson NM, Daccarett M, Windfelder J, McGann CJ, Parker D, MacLeod RS, Marrouche NF. Detection and quantification of left atrial structural remodeling with delayed-enhancement magnetic resonance imaging in patients with atrial fibrillation. Circulation. 2009;119(13):1758-1767. https://doi.org/10.1161/CIRCULATIONAHA.108.811877
Akoum N, McGann C, Vergara G, Badger T, Ranjan R, Mahnkopf C, Kholmovski E, Macleod R, Marrouche N. Atrial fibrosis quantified using late gadolinium enhancement MRI is associated with sinus node dysfunction requiring pacemaker implant. Journal of Cardiovascular Electrophysiology. 2012;23(1):44-50. https://doi.org/10.1111/j.1540-8167.2011.02140.x
McGann C, Kholmovski E, Blauer J, Vijayakumar S, Haslam T, Cates J, DiBella E, Burgon N, Wilson B, Alexander A, Prastawa M, Daccarett M, Vergara G, Akoum N, Parker D, MacLeod R, Marrouche N. Dark regions of no-reflow on late gadolinium enhancement magnetic resonance imaging result in scar formation after atrial fibrillation ablation. Journal of the American College of Cardiology. 2011;58(2):177-185. https://doi.org/10.1016/j.jacc.2011.04.008
Badger TJ, Oakes RS, Daccarett M, Burgon NS, Akoum N, Fish EN, Blauer JJ, Rao SN, Adjei-Poku Y, Kholmovski EG, Vijayakumar S, Di Bella EV, MacLeod RS, Marrouche NF. Temporal left atrial lesion formation after ablation of atrial fibrillation. Heart Rhythm. 2019;6(2):161-168. https://doi.org/10.1016/j.hrthm.2008.10.042
Marrouche NF, Wilber D, Hindricks G, Jais P, Akoum N, Marchlinski F, Kholmovski E, Burgon N, Hu N, Mont L, Deneke T, Duytschaever M, Neumann T, Mansour M, Mahnkopf C, Herweg B, Daoud E, Wissner E, Bansmann P, Brachmann J. Association of Atrial Tissue Fibrosis Identified by Delayed Enhancement MRI Assessment of Ablation-Induced Scarring in Atrial Fibrillation: Analysis from the DECAAF Study. JAMA. 2014;311(5):498-506. https://doi.org/10.1111/jce.12650
Benito EM, Cabanelas N, Nuñez-Garcia M, Alarcón F, Figueras I, Ventura RM, Soto-Iglesias D, Guasch E, Prat-Gonzalez S, Perea RJ, Borràs R, Butakoff C, Camara O, Bisbal F, Arbelo E, Tolosana JM, Brugada J, Berruezo A, Mont L. Preferential regional distribution of atrial fibrosis in posterior wall around left inferior pulmonary vein as identified by late gadolinium enhancement cardiac magnetic resonance in patients with atrial fibrillation. EP Europace. 2018;20(12):1959-1965. https://doi.org/10.1093/europace/euy095
Hansen BJ, Zhao J, Helfrich KM, Li N, Iancau A, Zolotarev AM, Zakharkin SO, Kalyanasundaram A, Subr M, Dastagir N, Sharma R, Artiga EJ, Salgia N, Houmsse MM, Kahaly O, Janssen PML, Mohler PJ, Mokadam NA, Whitson BA, Afzal MR, Simonetti OP, Hummel JD, Fedorov VV. Unmasking Arrhythmogenic Hubs of Reentry Driving Persistent Atrial Fibrillation for Patient‐Specific Treatment. Journal of the American Heart Association. 2020;9(19):e017789. https://doi.org/10.1161/JAHA.120.017789
Aryana A, Baker J H, Ginic MAE, Pujara DK, Bowers MR, O’Neill PG, Ellenbogen KA, Di Biase L, d’Avila A, Natale A. Posterior wall isolation using the cryoballoon in conjunction with pulmonary vein ablation is superior to pulmonary vein isolation alone in patients with persistent atrial fibrillation: a multicenter experience. Heart Rhythm. 2018;15(8):1121-1129. https://doi.org/10.1016/j.hrthm.2018.05.014