Non-invasive imaging in atrial fibrillation: focus on prognosis and catheter ablation

Imaging identifies patients with high-risk phenotype among the general population with atrial fibrillation, such as the presence of structural and valvular heart disease, which are both related to adverse outcome. Imaging is also potentially important for prediction of success of catheter ablation. Specifically, patients with larger left atrial size, reduced left atrial function and increased left atrial fibrosis content are more likely to experience atrial fibrillation recurrences after ablation. Routine and advanced echocardiographic imaging techniques and multi-detector row computed tomography and magnetic resonance imaging can provide detailed information. Currently, imaging techniques are not able to predict success on an individual basis, but it does permit identification of patients with high versus low risk of atrial fibrillation recurrence after ablation. Finally, imaging can be performed after ablation to demonstrate beneficial effects of restoration of sinus rhythm, including left atrial reverse remodelling and improvement in left atrial or ventricular function. All these issues are discussed in the current review.