Indices of left atrial remodeling in atrial fibrillation

Indices of left atrial remodeling in atrial fibrillation

Left atrial remodeling is an important change which occurs in chronic atrial fibrillation. Remodeling has an important role in maintaining chronic atrial fibrillation. In this respect it is also an important predictor of poor response after catheter ablation for atrial fibrillation. Some of the important indices of left atrial remodeling are:

  1. Minimum left atrial volume
  2. Left atrial emptying fraction
  3. Left atrial peak longitudinal strain
  4. Left atrial strain rate
  5. Left atrial fibrosis

All these parameters can be determined by cardiac magnetic resonance imaging (CMR). Left atrial fibrosis manifests as late gadolinium enhancement (LGE) on CMR studies using gadolinium based contrasts.

Left atrial peak longitudinal strain is measured using 2-dimensional speckle-tracking echocardiography. The measurement is based on the analysis of left atrial deformation during the reservoir phase [1].

In addition to this structural remodeling, there is an electrical remodeling which occurs in the left atrium, which can lead to perpetuation of atrial fibrillation.

Reference

  1. Ersbøll M, Andersen MJ, Valeur N, Mogensen UM, Waziri H, Møller JE, Hassager C, Søgaard P, Køber L. The prognostic value of left atrial peak reservoir strain in acute myocardial infarction is dependent on left ventricular longitudinal function and left atrial size. Circ Cardiovasc Imaging. 2013 Jan 1;6(1):26-33.