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Assessment of Atrial Fibrosis and Its Implications in Atrial Fibrillation and Stroke

  • Arrhythmia (R Kabra, Section Editor)
  • Published:
Current Treatment Options in Cardiovascular Medicine Aims and scope Submit manuscript

Abstract

Purpose of review

Cardiac magnetic resonance imaging (CMRI) can be used to accurately define atrial fibrosis burden and is increasingly available, which has led to a renaissance in our understanding of atrial fibrosis as a major component of the atrial disease substrate. The purpose of this review is to provide information on our current understanding of atrial fibrosis and its relation to atrial fibrillation (AFib) and stroke, highlight its implications in the treatment of these conditions, and discuss potential therapies for atrial fibrosis.

Recent findings

CMRI-defined atrial fibrosis has a proven utility in stratifying the response to catheter ablation for AFib and has led to recent interest in ablation strategies specifically targeting fibrotic areas. Atrial fibrosis may serve as the missing mechanistic link between AFib and embolic stroke, and ongoing studies may change treatment strategies for subsets of stroke patients. Recent animal studies suggest that atrial fibrosis may be modifiable in response to treatment of contributing risk factors such as obesity and sleep apnea.

Summary

Our understanding of atrial fibrosis and its relation to AFib and stroke is rapidly evolving. The presence of CMRI-defined atrial fibrosis may have a significant impact on the treatment paradigms for these conditions. The development and perpetuation of atrial fibrosis may be modifiable by pharmacologic and lifestyle interventions.

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Authors and Affiliations

  1. Atrial Fibrillation Program at the University of Washington, Seattle, WA, USA

    Bishoy Hanna MD & Nazem Akoum MD, MS

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  1. Bishoy Hanna MD
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Correspondence to Nazem Akoum MD, MS.

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Bishoy Hanna declares that he has no conflict of interest. Nazem Akoum declares that he has no conflict of interest.

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Hanna, B., Akoum, N. Assessment of Atrial Fibrosis and Its Implications in Atrial Fibrillation and Stroke. Curr Treat Options Cardio Med 23, 66 (2021). https://doi.org/10.1007/s11936-021-00952-z

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