The role of CT in detecting AF substrate

• Published in: Trends in cardiovascular medicine Vol. 31; no. 8; pp. 457 - 466
• Main Authors: Mangiafico, Valentina, Saberwal, Bunny, Lavalle, Carlo, Raharja, Antony, Ahmed, Zuhair, Papageorgiou, Nikolaos, Ahsan, Syed
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.11.2021; Elsevier Limited
• Subjects: Ablation; AF ablation; AF substrate; Atrial fibrillation; Atrial Fibrillation - diagnostic imaging; Atrial Fibrillation - therapy; Biomarkers; Cardiac arrhythmia; Cardiomyocytes; Catheter Ablation; Catheters; Computed tomography; Cytokines; Fibrillation; Gene expression; Heart Atria; Humans; Magnetic resonance imaging; Recurrence; Success; Tomography, X-Ray Computed; Treatment Outcome; DF; LGE-MRI; PVI; 18-FDG-PET; AF ablation; TTE; MRI; PV; PVWT; CE-MDCT; non-PAF; LLR; Ps-AF; CFAE; CV-WT; AF; Atrial fibrillation; CAF; LAA; CT; LAWT; PAF; LA; AF substrate; EAT; ECV; IAR
• ISSN: 1050-1738; 1873-2615; 1873-2615
• DOI: 10.1016/j.tcm.2020.10.004

Despite technological advancements and evolving ablation strategies, atrial fibrillation catheter ablation outcome remains suboptimal for a cohort of patients. Imaging-based biomarkers have the potential to play a pivotal role in the overall assessment and prognostic stratification of AF patients, allowing for tailored treatments and individualized care. Alongside consolidated evaluation parameters, novel imaging biomarkers that can detect and stage the remodelling process and correlate it to electrophysiological phenomena are emerging. This review aims to provide a better understanding of the different types of atrial substrate, and how Computed Tomography can be used as a pre-ablation risk stratification tool by assessing the various novel imaging biomarkers, providing a valuable insight into the mechanisms that sustain AF and potentially allowing for a patient-specific ablation strategy.