Evaluación de la fibrosis miocárdica de la aurícula izquierda mediante la imagen por resonancia magnética cardíaca en la fibrilación auricular.
Palabras clave:
fibrilación auricular, imagen por resonancia magnética, mapeo epicárdico, fibrosis
Resumen
La fibrilación auricular se inicia y se mantiene mediante factores desencadenantes y el sustrato auricular subyacente, por ende, se están utilizando técnicas de ablación modificadoras del sustrato anatómico. Sin embargo, ninguna de estas estrategias complementarias ha dado resultados consistentes. Las innovaciones en las técnicas de resonancia magnética nuclear cardíaca, especialmente las imágenes con realce tardío de gadolinio han mejorado nuestra capacidad para comprender mejor e identificar con precisión la fibrosis en el miocardio auricular de pacientes con fibrilación auricular. La consideración de la fibrosis auricular para el tratamiento terapéutico de la fibrilación auricular tiene el potencial de mejorar significativamente la comprensión y los resultados clínicos de la fibrilación auricular. Sin embargo, las técnicas de resonancia magnética nuclear cardíaca con realce tardío de gadolinio para evaluar la fibrosis de la aurícula izquierda todavía requieren de una experiencia significativa. Es necesario establecer más mejoras técnicas y métodos de obtención de imágenes más generalizados. Existe una amplia variación individual en la extensión de la fibrosis auricular izquierda en pacientes con fibrilación auricular. El mapeo de voltaje como herramienta para describir cambios fibróticos aún está bajo investigación. Depende de varias variables biológicas y tecnológicas y aún es necesario estandarizarlo. La combinación de un modelo de geometría pulmonar y de aurícula izquierda específico del paciente con una segmentación de cicatrices auriculares de procesamiento manual objetivo ciertamente será beneficiosa. Todas las estrategias de ablación más allá del aislamiento de las venas pulmonares, incluida la ablación guiada por fibrosis, deben confirmarse y validarse con respecto a la eficacia y la seguridad en estudios clínicos prospectivos multicéntricos aleatorizados.
Citas
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