Association between epicardial adipose tissue and embolic stroke after catheter ablation of atrial fibrillation

Abstract

Introduction Risk factors of embolic stroke (ES) after atrial fibrillation (AF) ablation have not been fully elucidated especially among the Asian subjects, particularly regarding epicardial adipose tissue (EAT) in cardiac imaging. We aimed to assess the incidence of ES during a long‐term follow‐up period after AF ablation and to identify the risk factors associated with postablation ES, specifically focusing on EAT. Methods and Results We enrolled patients who experienced postablation ES and control subjects from a consortium of AF ablation registries from three institutes in Korea. EAT was assessed using multislice computed tomography before AF ablation. A total of 3464 patients who underwent AF ablation were recruited and followed‐up. During a follow‐up of 47.2 ± 36.4 months, ES occurred in 47 patients (1.36%) with a CHA2DS2‐VASc score of 1.48 ± 1.39 and the overall annual incidence of ES was 0.34%. Compared with the control group (n = 190), the ES group showed significantly higher prior thromboembolism (TE) and AF recurrence rates, larger left atrium size, lower creatinine clearance rate (CCr), and greater total and peri‐atrial EAT volume. Multivariate regression analysis demonstrated larger peri‐atrial EAT volume (hazards ratio, 1.065; 95% confidence interval, 1.005‐1.128), in addition to a prior history of TE and lower CCr, was independently associated with postablation ES. When a cut‐off value of peri‐atrial EAT volume of ≥20.15 mL was applied, patients with smaller peri‐atrial EAT volume showed significantly higher ES‐free survival. Conclusion Larger peri‐atrial EAT volume, in addition to prior TE and lower CCr, was independently associated with postablation ES regardless of AF recurrence and CHA2DS2‐VASc score. (ClinicalTrials.gov number, NCT03479073).

Epicardial adipose tissue thickness assessed by CT is a marker of atrial fibrillation in stroke patients

“…9 Additionally, the long-term risk of embolic stroke in patients with AF submitted to catheter ablation is higher among patients with larger pEAT volume, and this association appears to be independent of AF recurrence. 10 In another study of patients with persistent AF, the majority of whom were not anticoagulated, increased pEATT was also associated with an increased risk of cardiovascular events. 11 A systematic review of 8 small studies has recently suggested an increased risk of stroke with increased epicardial adipose tissue, but there was marked heterogeneity in the study populations and methodologies.…”

“…In patients with AF undergoing pulmonary vein isolation, epicardial adipose tissue volume measured in CT is associated with AF recurrence 9 . Additionally, the long‐term risk of embolic stroke in patients with AF submitted to catheter ablation is higher among patients with larger pEAT volume, and this association appears to be independent of AF recurrence 10 . In another study of patients with persistent AF, the majority of whom were not anticoagulated, increased pEATT was also associated with an increased risk of cardiovascular events 11 .…”

Epicardial adipocytes in the pathogenesis of atrial fibrillation: An update on basic and translational studies

“…Increased EAT thickness has been associated with recurrence of AF after ablation ( 63 ). Larger peri atrial EAT volume is also related to the occurrence of embolic stroke after catheter ablation of AF ( 64 ). Some studies have failed to find an association between EAT and AF recurrence after catheter ablation, and it may depend on the stage of AF (paroxysmal vs. persistent) ( 65 ).…”

Peri‐atrial epicardial adipose tissue—a marker of thromboembolism?

“…The authors went on to perform receiver operator curve analysis and showed that a cut-off value of 20.15 mL resulted in an area under the curve of 0.658. Taken together, Ahn et al9 conclude from their data that peri-atrial EAT is independently associated with postablation embolic stroke and that assessment of peri-atrial EAT may have possible clinical utility in the identification of patients at higher risk. While Ahn et al 9 have provided further data supporting a possible link between EAT and the occurrence of postablation embolic stroke, larger studies are required to confirm this association and the potentially causative mechanisms established.…”

“…Ahn et al9 in the current issue of the Journal of Cardiovascular Electrophysiology. In this paper, the authors investigated the factors associated with embolic stroke after catheter ablation of AF over a long-term follow-up period.…”