title: The role of myocardial wall thickness in atrial arrhythmogenesis.
abstract: Changes in the structure and electrical behaviour of the left atrium are known to occur with conditions that predispose to atrial fibrillation (AF) and in response to prolonged periods of AF. We review the evidence that changes in myocardial thickness in the left atrium are an important part of this pathological remodelling process. Autopsy studies have demonstrated changes in the thickness of the atrial wall between patients with different clinical histories. Comparison of the reported tissue dimensions from pathological studies provides an indication of normal ranges for atrial wall thickness. Imaging studies, most commonly done using cardiac computed tomography, have demonstrated that these changes may be identified non-invasively. Experimental evidence using isolated tissue preparations, animal models of AF, and computer simulations proves that the three-dimensional tissue structure will be an important determinant of the electrical behaviour of atrial tissue. Accurately identifying the thickness of the atrial may have an important role in the non-invasive assessment of atrial structure. In combination with atrial tissue characterization, a comprehensive assessment of the atrial dimensions may allow prediction of atrial electrophysiological behaviour and in the future, guide radiofrequency delivery in regions based on their tissue thickness.
authors.affiliation: Electrophysiology Division of Cardiovascular Directorate and Division of Imaging Sciences and Biomedical Engineering, King's College London, 4th Floor, North Wing, St Thomas' Hospital, Westminster Bridge Road, London SE1 7EH, UK john.whitaker@kcl.ac.uk.
authors.forename: John
authors.initials: J
authors.lastname: Whitaker
authors.affiliation: Department of Cardiac Computed Tomography, Cardiovascular Directorate, Guy's and St Thomas NHS Foundation Trust, London, UK.
authors.forename: Ronak
authors.initials: R
authors.lastname: Rajani
authors.affiliation: Electrophysiology Division of Cardiovascular Directorate and Division of Imaging Sciences and Biomedical Engineering, King's College London, 4th Floor, North Wing, St Thomas' Hospital, Westminster Bridge Road, London SE1 7EH, UK.|Department of Paediatric Cardiology, Evelina London Children's Hospital, London, UK.
authors.forename: Henry
authors.initials: H
authors.lastname: Chubb
authors.affiliation: Electrophysiology Division of Cardiovascular Directorate and Division of Imaging Sciences and Biomedical Engineering, King's College London, 4th Floor, North Wing, St Thomas' Hospital, Westminster Bridge Road, London SE1 7EH, UK.
authors.forename: Mark
authors.initials: M
authors.lastname: Gabrawi
authors.affiliation: Electrophysiology Division of Cardiovascular Directorate and Division of Imaging Sciences and Biomedical Engineering, King's College London, 4th Floor, North Wing, St Thomas' Hospital, Westminster Bridge Road, London SE1 7EH, UK.
authors.forename: Marta
authors.initials: M
authors.lastname: Varela
authors.affiliation: Electrophysiology Division of Cardiovascular Directorate and Division of Imaging Sciences and Biomedical Engineering, King's College London, 4th Floor, North Wing, St Thomas' Hospital, Westminster Bridge Road, London SE1 7EH, UK.
authors.forename: Matthew
authors.initials: M
authors.lastname: Wright
authors.affiliation: Electrophysiology Division of Cardiovascular Directorate and Division of Imaging Sciences and Biomedical Engineering, King's College London, 4th Floor, North Wing, St Thomas' Hospital, Westminster Bridge Road, London SE1 7EH, UK.
authors.forename: Steven
authors.initials: S
authors.lastname: Niederer
authors.affiliation: Electrophysiology Division of Cardiovascular Directorate and Division of Imaging Sciences and Biomedical Engineering, King's College London, 4th Floor, North Wing, St Thomas' Hospital, Westminster Bridge Road, London SE1 7EH, UK.
authors.forename: Mark D
authors.initials: MD
authors.lastname: O'Neill
mesh_terms: D000818:Animals; D001281:Atrial Fibrillation / Q000503:physiopathology*; D064752:Atrial Remodeling; D001344:Autopsy; D004195:Disease Models, Animal; D006325:Heart Atria / Q000473:pathology*; D006329:Heart Conduction System / Q000000981:diagnostic imaging*; D006801:Humans; D008279:Magnetic Resonance Imaging; D014057:Tomography, X-Ray Computed
keywords: AF; Atrial fibrillation; Cardiac CT; Cardiac computed tomography; Left atrial wall thickness