Cardiac Arrhythmia Due to Epicardial Fat: Is It a Modifiable Risk?

Is epicardial fat tissue associated with atrial fibrillation recurrence after ablation? A systematic review and meta-analysis

“…The EFT has been also suggested to play a significant role in promoting arrhythmogenesis due to its pro-inflammatory properties and anatomical proximity to the myocardium [10,11]. Correspondingly, some believe that EFT has an additional role in the modulation of different triggers, including metabolic and biochemical triggers, leading to AF [12]. The relationship between increase in EFT amount and AF occurrence and severity has been similarly shown in several recent studies [13].…”

“…However, the effect of EFT reduction on the outcomes of AF ablation required different clinical trials, but the evidence from observational studies reviewed in this study supported the probable beneficial effects of EFT decline on post-ablation AF recurrence reduction. The study argument was also put on the grounds that: 1) EFT had a strategic location, which was mostly accumulated between the myocardium and the visceral pericardium, without any separating structure from the myocardium and the epicardial vessels [10,33,34]; 2) aside from the approved mechanisms of EFT effects on arrhythmia, EFT might have an effect on triggers from different sites, mainly pulmonary veins, that could interact with a remodelled atrial substrate to sustain AF [12]; 3) association between EFT and AF incidence had been proven in a recent meta-analysis [14], and 4) the present meta-analysis showed the evidence of EFT effects on AF recurrence. In fact, it was assumed that EFT reduction would have more beneficial effects on the outcomes of ablation rather than whole body weight loss through a targeted therapy strategy; however, the impact of whole body weight loss on the EFT reduction was certainly not negligible [35,36].…”