EHRA/HRS/APHRS/SOLAECE expert consensus on Atrial cardiomyopathies: Definition, characterisation, and clinical implication

Management of asymptomatic arrhythmias: a European Heart Rhythm Association (EHRA) consensus document, endorsed by the Heart Failure Association (HFA), Heart Rhythm Society (HRS), Asia Pacific Heart Rhythm Society (APHRS), Cardiac Arrhythmia Society of Southern Africa (CASSA), and Latin America Heart Rhythm Society (LAHRS)

“…A second possible mechanism for these observations is that frequent PACs alone may be a marker for a subclinical, atrial cardiomyopathy, that might promote both the development of AF and increased stroke risk. 21,23,24 This 'atrial cardiomyopathy hypothesis' proposes that the development of AF and PACs is an epiphenomenon outside the causal pathway between myopathy and stroke. Recent genetic studies showed an association between mutations in sarcomere genes and AF, a link that may be mediated through a subclinical atrial cardiomyopathy.…”

Noninvasive assessment of left atrial fibrosis. Correlation between echocardiography, biomarkers, and electroanatomical mapping

“…1 Left atrial fibrosis is the hallmark of atrial remodeling related with AF 2 and is associated with increased incidence of AF. 4 Robust and feasible method in diagnosis of LA fibrosis is a challenge in clinical practice. 3 Moreover, structural, functional, biochemical, and electrophysiological abnormalities of atria have been recently recognized as a new phenomena -atrial cardiomiopathy.…”

“…electrophysiological abnormalities of atria have been recently recognized as a new phenomena -atrial cardiomiopathy. 4 Robust and feasible method in diagnosis of LA fibrosis is a challenge in clinical practice. Late gadolinum-enhancement cardiovascular magnetic resonance imaging (LGE-MRI) is an established tool to image the fibrosis of myocardium, but is a time-consuming, costly procedure and requires extensive expertise for proper image acquisition and analysis.…”

Left Atrial Structural Remodelling in Non-Valvular Atrial Fibrillation: What Have We Learnt from CMR?

“…LA is a thin-walled structure of varying thickness (1 to 15 mm), postero-superior to the right atrium with its four pulmonary veins (PVs) located postero-superiorly in a dome-like shape [5]. The left atrial appendage (LAA) is narrower than that of the right atrium with over 90% of the thrombi of AF patients forming at this level.…”

“…Subsequently, imaging structural remodelling is necessary given its impact on CA candidate selection, technique and post-procedural outcomes and prognosis. Cardiac magnetic resonance with late-gadolinium enhancement (CMR-LGE) is the gold standard in imaging fibrosis [5], however, it is not widely available and different centres failed to reach an agreement regarding scanning protocols. We will further analyse the utility of various CMR-derived imaging parameters of LA structural remodelling, including size, shape and fibrosis (both extension and architecture) in relation to the index ablation procedure timing in non-valvular AF patients in terms of candidate selection, ablation strategy and post-procedural outcomes.…”