Brain MRI to personalise atrial fibrillation therapy: current evidence and perspectives

Advances in the access to and in the performance of brain MRI have led to an increased detection of asymptomatic abnormalities in the brain of patients with cardiovascular diseases. These may have prognostic impact and could influence management in the future. In this review, we summarise the main findings of brain MRI in patients with atrial fibrillation (AF) and explore the available evidence to better quantify the risk for intracerebral haemorrhage and (recurrent) ischaemic stroke based on brain MRI findings. Treatment decisions in the majority of patients with AF should still be based on data from established validated risk scores and large randomised trials. Whether brain MRI has the potential to improve the personalised management of patients with AF by guiding the risk and benefit assessment of stroke prevention by oral anticoagulants remains to be established in large prospective studies using standardised brain MRI. However, even today, brain MRI may help to identify subsets of patients with AF at increased risk for (recurrent) intracerebral bleeding. Although present knowledge and MRI-associated costs do not support routine use of brain MRI in asymptomatic patients with AF, as more data emerge MRI may become an increasingly useful way to stratify patients with AF and individualise their treatment.