心房纤维化评估与靶向干预策略的研究进展OA

Atrial fibrosis is the key mechanism underlying the initiation and maintenance of atrial fibril-lation(AF).Its assessment methods include late gadolinium enhancement-cardiac magnetic resonance(LGE-CMR),T1 mapping,echocardiography,and speckle-tracking echocardiography.LGE-CMR is currently the gold standard for non-invasive evaluation of atrial fibrosis.The delayed-enhancement MRI characterization of atrial fibrillation(DECAAF)study has confirmed that this technique can predict recurrence after AF catheter abla-tion.In terms of intervention strategies,the clinical efficacy of low-voltage area(LVA)ablation and MRI-guided ablation during catheter ablation remains controversial.Results from the DECAAF Ⅱ trial showed that fibrosis ablation combined with pulmonary vein isolation did not significantly improve prognosis.For pharma-cological interventions,renin-angiotensin-aldosterone system(RAAS)inhibitors,sodium-glucose cotransport-er 2(SGLT2)inhibitors,and glucagon-like peptide-1(GLP-1)receptor agonists exert potential therapeutic effects through anti-fibrotic actions and improving cardiac remodeling.Novel targets such as calcium-binding and coiled-coil domain 2(CALCOCO2)and microRNAs(miRNAs)provide new directions for reversing atrial fibrosis.Individualized treatment and precise assessment represent the core of atrial fibrosis management in future.