title: The role of left atrial imaging in the management of atrial fibrillation.
abstract: Atrial fibrillation (AF) is the most commonly encountered sustained cardiac rhythm disorder, is an independent risk factor for stroke, heart failure and death, and its development is promoted by a range of common cardiovascular pathologies. The management of AF is directed at these predisposing conditions, at reducing the risk of systemic thromboembolism, and towards rate or rhythm control of the arrhythmia. Guidelines increasingly support the use of catheter ablation (CA) as an early management strategy, with the efficacy of CA crucially dependent on the extent of left atrial (LA) structural remodeling; LA imaging plays a central role in each of identifying comorbidities, risk stratification for stroke, and identification of suitable candidates for CA. An understanding of the strengths and limitations of various echocardiographic modalities, of cardiac computed tomography and of cardiac magnetic resonance imaging is therefore an increasingly important part of the armory of the electrophysiologist. In particular, individualized use of imaging to select patients more likely to benefit from CA of AF is important, and post-procedural imaging to evaluate the extent of reverse LA remodeling after CA is critical to appropriate decisions regarding ongoing anti-arrhythmic therapy and long-term anticoagulation.
authors.affiliation: The Department of Cardiology, Royal Melbourne Hospital, Melbourne, Australia; The Department of Medicine, University of Melbourne, Melbourne, Australia.
authors.forename: Tomos E
authors.initials: TE
authors.lastname: Walters
authors.affiliation: The Department of Cardiology, Alfred Hospital and Baker IDI, Melbourne, Australia.
authors.forename: Andris H
authors.initials: AH
authors.lastname: Ellims
authors.affiliation: The Department of Cardiology, Royal Melbourne Hospital, Melbourne, Australia; The Department of Medicine, University of Melbourne, Melbourne, Australia. Electronic address: jon.kalman@mh.org.au.
authors.forename: Jonathan M
authors.initials: JM
authors.lastname: Kalman
mesh_terms: D001281:Atrial Fibrillation / Q000175:diagnosis* / Q000473:pathology / Q000503:physiopathology / Q000628:therapy*; D016279:Atrial Function, Left; D064752:Atrial Remodeling; D003952:Diagnostic Imaging / Q000379:methods*; D004452:Echocardiography; D006325:Heart Atria / Q000473:pathology* / Q000503:physiopathology*; D006801:Humans; D008279:Magnetic Resonance Imaging; D018579:Patient Selection; D011237:Predictive Value of Tests; D011379:Prognosis; D015203:Reproducibility of Results; D014057:Tomography, X-Ray Computed
keywords: Atrial fibrillation; Atrial strain analysis; Cardiac magnetic resonance imaging; Catheter ablation; Computed tomography; Echocardiography