Dr John Mandrola practices cardiac electrophysiology in Louisville, KY. He finished training at Indiana University in 1996. His practice encompasses catheter ablation, including an eight-year experience with AF ablation, device implantation, and consultative EP. Outside of the EP lab, Dr Mandrola's two hobbies include competitive cycling and writing. He has maintained a medical, fitness, and cycling blog, Dr John M, for the past two years.
Trials and Fibrillations with Dr John MandrolaView all posts »
Follow-up on atrial scarring/fibrosis: The Utah classificationSep 25, 2012 05:57 EDT
I've had a number of questions about left atrial scarring/fibrosis, and its permanency. Can structural disease of the atria be reversed? Can it be quantified? How is it important?
In this area, the leaders in the field are at the University of Utah. Led by Dr Nassir Marrouche, researchers at the University of Utah use delayed-enhancement techniques with cardiac MRI to classify the degree of atrial fibrosis.
Here is the link to the Utah classification of atrial fibrillation.
Although it is true that few labs can boast of the expertise with MRI that Dr Marrouche's team can, this is still highly relevant knowledge for AF clinicians—and patients.
Their words explain why:
The results of multiple studies indicate that the Utah Staging System (based on left atrial enhancement) can be used to personalize the management of AF. This model can be used to better define candidates for ablation, predict long-term prognoses, and, in the future, perhaps assess risks for strokes and heart failure. This staging system also can be beneficial in planning a corresponding ablation strategy and anticoagulation management based on an increase in the predictive statistics of the CHADS2, a clinical prediction rule for estimating the risk of stroke.
Strategies that promise to better personalize AF therapy are significant. This is the problem with antiarrhythmic drugs and AF ablation. Current treatment lacks specificity. Getting better at treating AF will require more thoroughly understanding its mechanisms, which will not likely be the same in all patients.
It's impressive work done in Utah.
PS. Another note on the future: This communication came to me directly from Dr Marrouche—via Twitter!