There is increasing recognition of the role of the atrial myopathy in the development of AF and AF-related stroke. Cardiac MRI (CMR) can be used to assess left atrial (LA) dimensions, function, strain, and fibrosis and novel techniques developed at Northwestern can now use 4D-CMR to evaluate LA and left atrial appendage flow and stasis. Thus far, current recommendations for rhythm maintenance and stroke prevention do not take into account any of the structural and functional alterations in the LA that contribute to AF maintenance and thromboembolic events. Given the moderate success rates of rhythm control treatments, including AF ablation, and the challenges in balancing stroke risk versus bleeds due to anticoagulation, it is clear that more effective strategies and clinical evidence for managing this common disease are needed. In direct response to these unmet needs, this proposal seeks to bridge major gaps in AF management by (i) identifying novel predictors of long-term sinus rhythm maintenance following pulmonary vein isolation (PVI) using advanced CMR imaging and serum biomarkers, (ii) exploring the link between LA myopathy, rhythm status, and potential stroke risk, and (iii) testing strategies for adjuvant targets for ablation and biologic therapies.. The scientific premise of this project is based on the emerging concept of the atrial myopathy as the underlying substrate for AF and stroke and our center's unique expertise in cutting-edge CMR methods to measure left atrial stasis, fibrosis, size and function. Building on the extensive resources already existing at Northwestern University, our experience in clinical electrophysiology, cardiac imaging, epidemiology, and basic science, and our longstanding history of AF research, we expect to achieve our aims with scientific rigor.
|Program type||Strategically Focused Research Network|
|Effective start/end date||07/01/2018 → 06/30/2022|