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Review
. 2022 Nov 4;8(11):300.
doi: 10.3390/jimaging8110300.

Role of Cardiovascular Magnetic Resonance in the Management of Atrial Fibrillation: A Review

Davide Tore  1 , Riccardo Faletti  1 , Andrea Biondo  1 , Andrea Carisio  2 , Fabio Giorgino  1 , Ilenia Landolfi  1 , Katia Rocco  1 , Sara Salto  1 , Ambra Santonocito  1 , Federica Ullo  1 , Matteo Anselmino  3 , Paolo Fonio  1 , Marco Gatti  1
Affiliations
Review

Role of Cardiovascular Magnetic Resonance in the Management of Atrial Fibrillation: A Review

Davide Tore et al. J Imaging. .

Abstract

Atrial fibrillation (AF) is the most common arrhythmia, and its prevalence is growing with time. Since the introduction of catheter ablation procedures for the treatment of AF, cardiovascular magnetic resonance (CMR) has had an increasingly important role for the treatment of this pathology both in clinical practice and as a research tool to provide insight into the arrhythmic substrate. The most common applications of CMR for AF catheter ablation are the angiographic study of the pulmonary veins, the sizing of the left atrium (LA), and the evaluation of the left atrial appendage (LAA) for stroke risk assessment. Moreover, CMR may provide useful information about esophageal anatomical relationship to LA to prevent thermal injuries during ablation procedures. The use of late gadolinium enhancement (LGE) imaging allows to evaluate the burden of atrial fibrosis before the ablation procedure and to assess procedural induced scarring. Recently, the possibility to assess atrial function, strain, and the burden of cardiac adipose tissue with CMR has provided more elements for risk stratification and clinical decision making in the setting of catheter ablation planning of AF. The purpose of this review is to provide a comprehensive overview of the potential applications of CMR in the workup of ablation procedures for atrial fibrillation.

Keywords: atrial fibrillation; cardiovascular magnetic resonance; catheter ablation; late gadolinium enhancement; strain.

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Conflict of interest statement

M.A. is a consultant for Biosense Webster and Boston Scientific, serves as clinical proctor for Medtronic, and has received educational support from Abbott. The authors declare that they have no role in writing, review, or other processes that may affect the writing of the manuscript. The other authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Panel (A), normal pulmonary veins anatomy; panel (B), left PV common trunk; and panel (C), right accessory pulmonary vein.
Figure 2
Figure 2
Left atrial appendage morphology on CMR images: Panel (A): chicken wing; panel (B): wind sock; panel (C): cactus; and panel (D): cauliflower.
Figure 3
Figure 3
CMR images depicting the anatomical relationship between the esophagus (indicated with the asterisk): Panel (A): axial plane, angiographic CMR acquisition; panel (B–D) 3D volume rendering.
Figure 4
Figure 4
Left atrial fibrosis staging with LGE-CMR images elaborated with ADAS 3DTM (ADAS3D Medical, Barcelona, Spain) before catheter ablation: Panel (A) anterior LA wall; panel (B) posterior LA wall. Estimated fibrosis: 12%, Utah stage II.
Figure 5
Figure 5
Panel (A): preprocedural LGE; postprocedural LGE at 24 h (panel (B)) and 30 days (panel (C)) after cryoablation. Red arrows indicate the pulmonary vein ostia.
Figure 6
Figure 6
Quantification of preprocedural fibrosis (panel (A,C) and postprocedural fibrosis (B,D) on LGE-CMR images on ADAS 3DTM (ADAS3D Medical, Barcelona, Spain).
Figure 7
Figure 7
Hybrid imaging: Electoanatomic (Carto v7, Biosense Webster) voltage map of the left atrium (healthy tissue >0.24 mV, in violet); posterior view on the left and right lateral view on the right showing multipolar mapping catheter in the right inferior pulmonary vein antra. The ablation catheter (green vector) is pointing toward the posterior antrum of the vein with a real time 11 g contact force (value reported in light blue in the center of the image). Pink dots represent ablation sites.
Figure 8
Figure 8
Manual segmentation of periatrial fat and volume rendering on a 3D IR spoiled gradient echo LGE acquisition with 3DSlicer (slicer.org, accessed on 10 June 2022).
See this image and copyright information in PMC

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