Atrial Fibrillation and Fibrosis: Still a strict link? Johannes Brachmann
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1 Klinikum Coburg Atrial Fibrillation and Fibrosis: Still a strict link? Johannes Brachmann Prof. Dr. med. J. Brachmann Bologna 16 th February 2017
2 Disclosures Study Grants: Biotronik, Medtronic, SJM, Abbott, Sorin, Boston Speaker Honoraria: Sanofi, AstraZeneca, Novartis, SJM Travel grants: Daiichi, Biotronik, SJM, Bayer
3 Kottkamp H et al. J Am Coll Cardiol 2015
4 Longterm Success Rate of AF Still Unsatisfactory Ouyang et al. 2010, Circulation Weersooriya et al. 2011, JACC Wokhlu et al. 2010, JCE Winkle RA, Am Heart J 2011
5 Primary Efficacy End Point of the FIRE and ICE Trial Modified ITT analysis HR [95% CI] = 0.96 [ ]; p = Non-inferiority hypothesis met Superiority test: p = 0.74 Kuck et al NEJM 2016
6 Kirchhof P et al.; Europace 2013;15:
7 Personalized management of AFIB Kirchhof P et al.; Europace 2013;15:
8 Detection of LA Fibrosis by Delayed Enhancement (DE) - MRI Marrouche et al; JAMA 2014;311:
9 Quantification of LA Fibrosis by Delayed Enhancement (DE) - MRI Marrouche et al; JAMA 2014;311:
10 Struktural Abnormalities DE-MRI Cochet et al. J Cardiovasc Electrophysiol (5):
11 Struktural Abnormalities DE-MRI Cochet et al. J Cardiovasc Electrophysiol May;26(5):
12 Struktural Abnormalities DE-MRI Habibi M et al.; Heart Rhythm Sep
13 Strukturelle Veränderungen DE-MRT Habibi M et al.; Heart Rhythm Sep
14 Clinical Significance of Structural Changes Allessie, M. et al. Cardiovasc Res : Boldt et al; Heart Apr; 90(4):
15 Clinical Significance of Structural Changes permanent AF paroxysmal AF no AF Permanent Paroxysmal Sinusrhythmus Platonov et al. JACC 2011 A = permanent AF (51%) B = paroxysmal AF (14%) C = without AF (5%) Fibrosis ext ent in at rial wall Platonov et al.; JACC 2011
16 Histological Verification of LA Fibrosis Detected by DE-MRI Normal Fibrosis Scar
17 LA Cardiomyopathy a Progressive Disease I II III IV Goldberger JJ el al. Circulation 2015;132:
18 Thrombogenesis and AF Hirsh B. Et et al.; J Am Coll Cardiol. 65, 201
19 Thrombogenesis and AF Watson, Shantsila and Lip, The Lancet 2009
20 Thrombogenesis and AF The Vircohw Trias Revisited
21 Clinical Significance of LA Fibrosis in Stroke?
22 J Am Coll Cardiol Feb 15;57(7):831-8.
23 Association of LA Fibrosis and Stroke Risk N = ,4% 16,1% Daccarett et al J Am Coll Cardiol Feb 15;57(7):831-8.
24 Association of LA Fibrosis and Stroke Risk J Am Coll Cardiol Feb 15;57(7):831-8.
25 Association of LA Fibrosis and LAA Thrombus Formation Akoum et al, JCE 2013
26 Association of LA Fibrosis and LAA Thrombus Formation ±8% ±8% 8±9% 0 Normal Smoke Thrombus
27 Can We Predict Clinical Outcome of AF Ablation by DE-MRI? Thema des Vortrages
28 USA: 6 Europe: 8 Australia: 1 Marrouche N,.. BrachmannJ. et al, JAMA Feb 5;311(5):
29 Association of LA Fibrosis and Outcome of AF Ablation Marrouche N,.. BrachmannJ. et al, JAMA Feb 5;311(5):
30 Personalized Management of AFIB Kirchhof P et al.; Europace 2013;15:
31 Personalized Management of AFIB Normal Fibrosis
32 Personalized Management of AFIB Normal Fibrose Narbe
33 Personalized Therapy of AF Kottkamp H et al. J Am Coll Cardiol 2015
34 Detection of Induced Scar Tissue McGann CJ, et al J Am Coll Cardiol. 2008: 52(15):
35 Detection of Induced Scar Tissue McGann CJ, et al J Am Coll Cardiol. 2008: 52(15):
36 DECAAF Subanalysis of Ablation-Induced Scarring in AF Akoum et al.; J Cardiovasc Electrophysiol. 26, , 2015
37 DECAAF Detection of the Residual Fibrosis after AF Ablation Akoum et al.; J Cardiovasc Electrophysiol. 26, , 2015
38 DECAAF Subanalysis of Ablation-Induced Scarring in AF Akoum et al.; J Cardiovasc Electrophysiol. 26, , 2015
39 DECAAF Subanalysis of Ablation-Induced Scarring in AF Akoum et al.; J Cardiovasc Electrophysiol. 26, , 2015
40 DECAAF Significance of Residual Fibrosis Detected by DE-MRI for Outcome of AF Ablation Akoum et al.; (J Cardiovasc Electrophysiol. 26, , 2015
41 DECAAF II Workflow About 888 adults will be enrolled in this study over 2 years. 41
42 DECAAFII Workflow About 888 adults will be enrolled in this study over 2 years. 42
43 Conclusions Detection of left atrial fibrosis by delayed-enhancement MRI is feasible and allows quantitative analysis and supports the concept of a left atrial cardionmyopathy. Stroke risk and left atrial thrombus formation may be related to the degree of left atrial alterations. Employing DE-MRI has been shown to improve prediction of clinical longterm success of AF ablation. The determination of residual left atrial fibrosis offers the opportunity for an individualized approach to AF ablation which is currently studied in the DECAAF II-Trial.
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