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Published on: July 20, 2022
Three-Dimensional Left Atrial Geometry in Atrial Fibrillation: Imaging Biomarkers, Substrate Phenotyping, and
Paschalis Karakasis1, Panagiotis Theofilis2, Panagiotis Stachteas1
1Second Department of Cardiology, Hippokration General Hospital, Aristotle University of Thessaloniki, Konstantinoupoleos 49, 54642 Thessaloniki, Greece.
Three-dimensional left atrial geometry offers a detailed view beyond traditional measurements for atrial fibrillation (AF) assessment. This advanced imaging can improve understanding of AF persistence, stroke risk, and ablation success, guiding personalized treatment strategies.
Area of Science:
- Cardiology and Medical Imaging
- Computational Anatomy and Biomechanics
- Electrophysiology
Background:
- Traditional assessment of left atrial remodeling in atrial fibrillation (AF) relies on limited scalar measures like volume and diameter.
- These conventional metrics fail to capture the complex, asymmetric 3D geometry of the left atrium, crucial for understanding AF pathophysiology.
- A more comprehensive spatial characterization is needed to predict AF persistence, thromboembolic events, and outcomes after catheter ablation.
Purpose of the Study:
- To review the role of three-dimensional (3D) left atrial geometry in advancing AF assessment beyond traditional size metrics.
- To explore how 3D geometric features can characterize the atrial substrate and improve prediction of clinical outcomes.
- To discuss the integration of 3D geometry with emerging technologies and future directions in AF management.
Main Methods:
- Review of existing literature on 3D left atrial reconstruction techniques, including CT, CMR, 3D echocardiography, and EAM.
- Analysis of key geometry-derived metrics such as sphericity, asymmetry, eccentricity, PV and LAA morphology, and wall thickness.
- Synthesis of evidence linking geometric remodeling to atrial cardiomyopathy, fibrosis, electrical substrate, and ablation outcomes.
Main Results:
- 3D left atrial geometry provides a more refined assessment of the atrial substrate compared to traditional scalar descriptors.
- Specific geometric features correlate with atrial cardiomyopathy, fibrosis, low-voltage substrate, and outcomes of catheter ablation.
- Emerging technologies like pulsed field ablation (PFA) may alter the significance of geometric predictors.
Conclusions:
- 3D left atrial geometry offers a powerful tool for detailed atrial phenotyping in AF.
- Standardization of metrics, validation, and integration with AI and other data sources are essential for clinical implementation.
- While not yet standalone, 3D geometry is poised to become central to individualized AF management and rhythm control decisions.
