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Cardiac imaging for atrial fibrillation management

ESC Congress 2010

Atrial Fibrillation

Atrial fibrillation (AF) is the most common cardiac rhythm disorder in clinical practice. The estimated prevalence of AF is 0.4–1% in the general population, increasing with age to 8% in patients older than 80 years. The recognized risk factors for developing AF include age, hypertension, structural heart disease, diabetes mellitus and hyperthyroidism. How we can identify the characteristics of the atrium at risk of atrial fibrillation? Atrial dilatation, left atrial volume >24 ml/m², atrial deformation (strain about 20-25 %) can define the atrial risk, says Dr Leung from Liverpoool.

Dr Sitges from Barcelona presented the use of imaging in selection of the right therapeutic strategy. Whether you choose heart rhythm control or cardioversion depends on information obtained by echocardiography and MRI. A very large left atrium, low appendage velocity, and depression of deformation index can induce heart control. Otherwise good deformation index, volumes less than 32 ml/m² can justify cardioversion.

The imaging modalities can also guide antithrombotic therapy, as Dr. Paolo Colonna from Bari, Italy explained, in patients with atrial fibrillation that need cardioversion evaluating dimension and function of the atrium. The presentation by Dr. Colonna showed the utility of cardiac imaging to guide antithrombotic therapy in atrial fibrillation. At first, transoesophageal echocardiography is useful to shorten the pre-cardioversion time, as recently confirmed in the 2010 atrial fibrillation guidelines from the ESC. Moreover, cardiac imaging can be used to define the selection of patients who need anticoagulation. The presence on transoesophageal echocardiography of left atrial thrombus, complex aortic plaques, spontaneous echo-contrast and low atrial appendage velocities are independent predictors of stroke and thrombo-emboli. After cardioversion, anticoagulation is necessary for four weeks for stunned phenomena. We can reduce this time to one week if a second TEE is performed and good appendage velocities are observed.

Which imaging technique before, during and after atrial fibrillation ablation? Echocardiography is the better technique for selection and evaluation of patients during and after ablation. We can use transthoracic and transesopahgeal echo before, and intracardiac echo (ICE) during ablation to localize the ablation area and for complications, while transthoracic echo can be used after ablation to show recovery of atrial wall with new technologies such as strain and strain rate. Furthermore, MRI and CT angio are able to help in selection of patients, and after ablation for better evaluation of the pulmonary vein.




Cardiac imaging for atrial fibrillation management

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.