5.3 Benefit of non-invasive imaging
Function of LAA is difficult to measure and transesophageal
echocardiography is virtually only available option. Although abnormal
LAA function is a known risk factor for ischemic stroke in AF patients,
it is not incorporated into CHA2DS2-VASc
scoring system.4-8,
22 Main reason is that transesophageal
echocardiography (i) is an invasive imaging test; (ii) has rare but
serious complications such as esophageal injury; (iii) is associated
with patient discomfort related with the insertion of the probe usually
requiring sedatives; and (iv) requires well trained cardiologist to
perform and therefore is not an anytime available test. Recent studies
revealed that LAA flow volume measured with VENC-MRI can reliably
predict LAA
hemodynamics.9,
10 Since VENC-MRI is a non-invasive
imaging test that do not require inconvenient probe insertion, it has a
potential for disseminated use. The role of VENC-MRI in the prediction
of ischemic stroke and assessing the result of RFCA in AF patients
warrants large randomized clinical trials.