Effect of Echocardiographic Epicardial Adipose Tissue Thickness on Success Rates of Premature Ventricular Contraction Ablation

Abstract

Background:Idiopathic premature ventricular contractions are frequently detected ventricular arrhythmias, and radiofrequency ablation is an effectively treatment for improving symptoms and eliminating premature ventricular contractions. Studies have reported a relationship between an elevated epicardial adipose tissue thickness and myocardial structural pathologies. However, the association between epicardial adipose tissue thickness and success rates of premature ventricular contraction ablation has not yet been investigated.Aims:To assess the relationship between epicardial adipose tissue thickness and success rates of premature ventricular contraction ablation.Study Design:Retrospective case-control study.Methods:This study enrolled a total of 106 consecutive patients who have had a high premature ventricular contraction burden of >10,000/24-h assessed using ambulatory Holter monitorization and underwent catheter ablation. A frequency of premature ventricular contractions of more than 10,000/day was defined as frequent premature ventricular contraction. Epicardial adipose tissue thickness was measured using 2D transthoracic echocardiography. A successful ablation was defined as >80% decrease in pre-procedural premature ventricular contraction attacks with the same morphology during 24-h Holter monitorization after a 1-month follow-up visit from an ablation procedure.Results:Successful premature ventricular contraction ablation was achieved in 87 (82.1%) patients. Epicardial adipose tissue thickness was significantly higher in patients with unsuccessful ablation (p<0.001). Procedure time, total fluoroscopy time, and radiofrequency ablation time were statistically higher in the unsuccessful group (p<0.001). Stepwise multivariate logistic regression analysis showed that epicardial adipose tissue thickness and pseudo-delta wave time were independently associated with procedural success (both p values <0.001). In the receiver-operating curve analysis, epicardial adipose tissue thickness was found to be an important predictor for procedural success (area under the receiver-operating characteristic curve= 0.85, p=0.001), with a cutoff value of 7.7 mm, a sensitivity of 92%, and a specificity of 68%.Conclusion:Epicardial adipose tissue thickness is higher in patients with premature ventricular contraction ablation failure, which may be indicative of procedural success.

The Relationship Between Epicardial Fat Tissue Thickness and Risk of Frequent Premature Ventricular Contractions

“…All these changes may predispose the heart to arrhythmias such as ventricular extra-systoles. 6,23 However, much uncertainty still exists about the relation between EFT thickness and PVCs. Surveys such as that conducted by Nabati et al have shown a significant association between increased EFT thickness and some cardiovascular risk factors, including calcium deposits in the mitral valve annulus.…”

“…3,5 The amounts of PVC attacks of more than 10-25% of total heart beats in a day have been reported to be associated with decreased ventricular function, ventricular dilation, and increased risk of cardiomyopathy. 2,6 Related risk factors and etiology of PVC are not fully known in patients with normal heart structure. However, some cardiac disorders such as ischemia, myocardial hypertrophy, cardiomyopathy and chronic heart failure have been reported to be potential predisposing factors in developing frequent PVCs in patients suffering from structural heart diseases.…”

“…There is a close anatomical and functional relationship between EFT and myocardium. 6,8 EFT has been a topic of interest lately because of its detrimental effects on the cardiovascular system due to its role in inflammation, insulin resistance, high levels of free fatty acids and beta-adrenergic activity. 9 As mentioned in the previous literature, an association between EFT and structural and ultrastructural cardiac changes such as left ventricular and atrium enlargement, atherosclerosis, hypertension, diastolic dysfunction as well as atrial fibrillation has been found.…”

Cardiac Adiposity and Arrhythmias: The Role of Imaging

“…Additionally, EAT was an independent marker of impaired heart rate recovery, a noninvasive index of autonomic nerve dysfunction in obese patients with obstructive sleep apnea, portending poor cardiovascular prognosis in obese patients [ 119 ]. Finally, echocardiography-derived EAT thickness was higher in patients with premature ventricular contraction ablation failure [ 120 ].…”

Melissa officinalis tea favourably affects the frequency of premature ventricular beats and cardiometabolic profile among patients with premature ventricular contraction: A randomised open‐label controlled trial

“…1,2,6 Frequent PVCs are defined as attacks of >10%-25% of the total number of heartbeats detected by 24-hour rhythm Holter monitoring. 7 The related risk factors are not entirely known yet, but some structural heart diseases such as ischaemia, myocardial hypertrophy, cardiomyopathy and chronic heart failure have been noted to be in association with PVCs; therefore, patients with more frequent PVCs should undergo meticulous evaluation of underlying heart diseases as frequent PVCs can be contributed to increased mortality rate because of arrhythmia-induced cardiomyopathy. 2,8,9 Further, several studies have demonstrated that PVCs have a considerable impact on increasing the risk of cardiovascular adverse effects, including left ventricular systolic and diastolic dysfunction in addition to decreased cardiac capacity, serious events related to arrhythmia (eg, ventricular fibrillation or ventricular tachycardia), myocardial infarction (MI) and ischaemic stroke.…”