Dynamic risk assessment to improve quality of care in patients with atrial fibrillation: the 7th AFNET/EHRA Consensus Conference.

AIMS: The risk of developing atrial fibrillation (AF) and its complications continues to increase, despite good progress in preventing AF-related strokes. METHODS AND RESULTS: This article summarizes the outcomes of the 7th Consensus Conference of the Atrial Fibrillation NETwork (AFNET) and the European Heart Rhythm Association (EHRA) held in Lisbon in March 2019. Sixty-five international AF specialists met to present new data and find consensus on pressing issues in AF prevention, management and future research to improve care for patients with AF and prevent AF-related complications. This article is the main outcome of an interactive, iterative discussion between breakout specialist groups and the meeting plenary. AF patients have dynamic risk profiles requiring repeated assessment and risk-based therapy stratification to optimize quality of care. Interrogation of deeply phenotyped datasets with outcomes will lead to a better understanding of the cardiac and systemic effects of AF, interacting with comorbidities and predisposing factors, enabling stratified therapy. New proposals include an algorithm for the acute management of patients with AF and heart failure, a call for a refined, data-driven assessment of stroke risk, suggestions for anticoagulation use in special populations, and a call for rhythm control therapy selection based on risk of AF recurrence. CONCLUSION: The remaining morbidity and mortality in patients with AF needs better characterization. Likely drivers of the remaining AF-related problems are AF burden, potentially treatable by rhythm control therapy, and concomitant conditions, potentially treatable by treating these conditions. Identifying the drivers of AF-related complications holds promise for stratified therapy.

Assessment of left atrial function by MRI myocardial feature tracking.

BACKGROUND: Left atrium (LA) volumes and function are predictors of cardiovascular events. Because LA function cannot be assessed from cardiovascular magnetic resonance imaging (MRI) using the well-established left ventricular tagging techniques, we hypothesized that adequate feature tracking (FT) applied to conventional cine MRI data could characterize LA function accurately. METHODS: We studied 10 young (28 ± 7 years) and 10 elderly (64 ± 6 years) healthy subjects, as well as 20 patients with moderate to severe aortic valve stenosis (AVS; 73 ± 15 years, effective aortic valve area: 0.67 ± 0.36 cm(2) ). MRI cine two-, three-, and four-chamber views were analyzed using a newly proposed FT method based on spatial correlation and endocardial detection resulting in: regional and global longitudinal strain and strain rate, radial motion fraction and relative velocity for the three LA motion phases including reservoir, conduit, and LA contraction. RESULTS: FT reliability was indicated by a good overlap between tracking results and manual LA endocardial borders, the low error for comparison against theoretical strains introduced in a synthetic phantom and the good inter-observer reproducibility (coefficient of variation < 15%). While all LA functional parameters were significantly impaired in AVS patients (p < 0.04), subclinical age-related variations induced a decreasing trend on all LA parameters but were significant only for radial conduit function parameters (p < 0.03). Finally, LA functional parameters characterized LA alteration in AVS with higher sensitivity than conventional LA volumetric parameters. CONCLUSIONS: Left atrial FT is feasible on MRI cine images and its addition to conventional analysis tools might enhance the diagnosis value of MRI in many heart diseases.