Atrial fibrillation and diffuse left ventricular fibrosis, a causal association?

Late gadolinium enhanced magnetic resonance imaging (MRI) is an established technique for quantification of dense myocardial fibrosis (1). Cohesive regions of myocardial fibrosis, such as infarcted myocardium, are characterized by expanded extracellular matrix due to replacement of normal myocytes with collagen. Gadolinium contrast agents perfuse into and wash out of normal myocardium relatively rapidly. However, because of increased extracellular matrix and decreased capillary density, gadolinium contrast is retained within fibrotic myocardium (2). Late gadolinium enhanced MRIs are obtained by using an inversion recovery pulse that suppresses the signal from normal myocardium and results in hyperenhancement of signal from the gadolinium retained in dense myocardial fibrosis (3). If the