2025 THRS Expert Consensus of Imaging Assessment in Atrial Fibrillation. Developed by the Task Force of the Taiwan Heart Rhythm Society (THRS) Imaging Committee. Endorsed by the Taiwan Society of Cardiology (TSOC).

Abstract

Atrial fibrillation (AF) is the most common form of cardiac arrhythmia in the elderly population with a high lifetime risk after the age of 45 years, leading to a major impact on the public health from elicited left atrial (LA) thrombogenesis and cardioembolic stroke. Imaging in the AF population plays a crucial role, not only in assessing LA size but also in delineating the underlying cardiac structural and functional features to reach a more specific diagnosis. Contemporary clinical practice guideline recommended anticoagulation therapy based on annual thromboembolic event risk using a validated clinical risk score. However, patients who remain uncertain about the anticoagulation may benefit from considering other risk variables or markers, such as bedside atrial imaging, to help inform the clinical decision. In this regard, imaging in the diagnosis, potential etiology and thromboembolic risks of AF can facilitate decisions about anticoagulation therapy among patients at an intermediate annual risk. Additionally, the implementation of advanced imaging for catheter-based interventions, such as catheter ablation, further provides pivotal anatomical and pathophysiological insights during procedures and assists in monitoring after therapeutic delivery. Our current consensus offers an overview highlighting the evolution, strengths, and advances of these imaging techniques and tools, whether using invasive or non-invasive modalities, and their potential to supplement precision medicine in the context of AF.