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Innovation in atrial fibrillation therapy

EuroEcho-Imaging 2014 session report

Left atrium assessment and left atrium fibrosis among the areas where innovations in atrial fibrillation are revolutionizing practice.

This was a session of very high quality. The attendance was limited at the end of the day for a very up-to-date session.

We started with a marvellous overview of the assessment of the left atrium by M Rosca (Bucharest, RO). It was an echocardiography talk emphasizing the importance of measuring left atrial volume using the bi-plane 2D method nowadays, but hopefully soon by 3D. She also provided arguments for pushing the use of speckle tracking to better assess the left atrium.

The second talk was astonishing; we had the opportunity to get the most recent data from Nassir Marrouche (Salt Lake City, US) about how to identify left atrial fibrosis by CMR and how to use this quantitative information to optimise treatment of the individual patient. He provided results and latest analyses from the DECAAF-study, explaining that instead of proposing only isolation of the pulmonary vein ostia, isolation of the left atrial roof fibrotic tissue could also be proposed. He was also able to show data about the amount of residual fibrosis after atrial fibrillation ablation and the impact on the thromboembolic risk and risk of atrial fibrillation recurrence. It appeared clearly that CMR would probably become mandatory in the very near future for patients with atrial fibrillation who could be treated by ablative approaches.

The importance of CMR for the future was also highlighted by OA Breithardt (Leipzig, Germany) who gave a complete overview of what could be done now and in the near future in the cathlab for best applying ablative therapies to every single patient. CMR seems to be the future and 3D rotational angiography seems to be a great opportunity today. He reported findings demonstrating better results with 3D rotational angiography than with CT, and better than contact electro-magnetic mapping alone.

There was also an overview (by E. Donal) of the potential advantages of speckle tracking-derived left atrial strain assessment with new data demonstrating the added value of left atrial strain to best predict thromboembolic risk and success rate of ablation therapy.

Left atrial strain is not routinely used but rather robust and easy to obtain. Further studies appear mandatory and hopefully, large series of patients will be convincing enough to integrate this in the guidelines.




Innovation in atrial fibrillation therapy

The content of this article reflects the personal opinion of the author/s and is not necessarily the official position of the European Society of Cardiology.