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Estimating Bilateral Atrial Function by Cardiovascular Magnetic Resonance Feature Tracking in Patients with Paroxysmal Atrial Fibrillation
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Chamber-specific wall thickness features in human atrial fibrillation.

Jichao Zhao1, James Kennelly1, Aaqel Nalar1

  • 1Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand.

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|December 18, 2023
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Summary

Persistent atrial fibrillation (AF) drivers have distinct atrial wall thickness (AWT) features. Right atrial driver regions are thicker with more AWT variation, while left atrial drivers are thinner, guiding targeted ablation strategies.

Keywords:
atrial fibrillationatrial wall thicknesscardiac arrhythmogenesishuman atria

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Area of Science:

  • Cardiovascular Research
  • Medical Imaging
  • Electrophysiology

Background:

  • Persistent atrial fibrillation (AF) treatment is limited by the lack of tools to identify patient-specific AF substrates.
  • Localized drivers in both the right atrium (RA) and left atrium (LA) maintain persistent AF in 30-50% of patients.
  • Chamber-specific atrial wall thickness (AWT) features underlying AF drivers remain poorly understood despite AWT's known role.

Purpose of the Study:

  • To provide direct evidence of distinct RA and LA AWT features associated with AF drivers.
  • To analyze chamber-specific AWT characteristics in human atria ex vivo using advanced imaging and mapping techniques.

Main Methods:

  • Coronary-perfused human atria (n=7) underwent pacing-induced AF and panoramic near-infrared optical mapping.
  • High-resolution (170 µm³) 9.4 T gadolinium-enhanced MRI was used for structural imaging.
  • 3D AWT was segmented and analyzed throughout the atrial chambers, correlating with identified AF driver locations.

Main Results:

  • Optical mapping identified localized RA drivers (n=4 hearts) and LA drivers (n=3 hearts).
  • RA with drivers showed thicker AWT and greater AWT variation compared to RA without drivers (p < 0.05). RA driver regions were significantly thicker and more variable (p < 0.05).
  • LA with drivers was thinner than LA without drivers. LA driver regions were significantly thinner than other LA regions (p < 0.05).

Conclusions:

  • This study demonstrates chamber-specific AWT features differentiating AF driver regions in RA and LA.
  • Right atrial driver regions exhibit increased thickness and AWT variability, contrasting with thinner left atrial driver regions.
  • Patient-specific evaluation of AWT should be considered for developing chamber-specific, targeted ablation strategies for persistent AF.