Abstract
Atrial fibrillation ablation is a complex and challenging procedure. Appropriate patient selection is the most critical step to ensure safe and successful atrial fibrillation ablation procedure. The DECAAF study (Delayed-Enhancement MRI Determinant of Successful Radiofrequency Catheter Ablation of Atrial Fibrillation) showed that atrial tissue fibrosis, as estimated by delayed enhancement magnetic resonance imaging, was independently associated with recurrent arrhythmia post atrial fibrillation ablation. Magnetic resonance imaging also detected left atrial volume and shape. Integrating the data provided by magnetic resonance imaging into the pre-procedural planning is crucial.
Highlights
Atrial fibrillation (AF) is the most common arrhythmia in clinical practice and is associated with increased morbidity, mortality, and represents a financial burden in healthcare
There is a consistent body of evidence showing that left atrial remodelling has deterministic value in the development and progression of AF
It was observed that patients with dilated left atria are more likely to relapse after ablation of AF, making left atrial size a well established risk factor for AF recurrence after AF ablation[9]
Summary
Atrial fibrillation (AF) is the most common arrhythmia in clinical practice and is associated with increased morbidity, mortality, and represents a financial burden in healthcare. Many studies have targeted the predictors of AF recurrence, such as patients’ age and gender, left atrial size, type and duration of AF, left ventricular systolic dysfunction or heart failure, structural or valvular heart disease, and number of attempted ablation procedures[4,5]. Among these predictors, left atrial fibrosis has been established as an independent determinant for success of rhythm control strategies in AF. The DECAAF trial studied atrial tissue fibrosis estimation by delayed enhancement magnetic resonance imaging (DE-MRI) and its association with subsequent AF ablation outcome[6]. 64% and 54% of patients with stage 2 and 3 fibrosis were arrhythmia-free at one year
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