Indexed Left Atrial Adipose Tissue Area Is Associated With Severity of Atrial Fibrillation and Atrial Fibrillation Recurrence Among Patients Undergoing Catheter Ablation

Abstract

Background: Epicardial adipose tissue (EAT) has been associated with adverse left atrial (LA) remodeling and atrial fibrillation (AF) outcomes, possibly because of paracrine signaling.Objectives: We examined factors associated with a novel measure of EAT i.e., indexed LAEAT (iLAEAT) and its prognostic significance after catheter ablation (CA) of atrial fibrillation (AF).Methods: We performed a retrospective analysis of 274 participants with AF referred for CA. LAEAT area was measured from a single pre-ablation CT image and indexed to body surface area (BSA) to calculate iLAEAT. Clinical, echocardiographic data and 1-year AF recurrence rates after CA were compared across tertiles of iLAEAT. We performed logistic regression analysis adjusting for factors associated with AF to examine relations between iLAEAT and AF recurrence.Results: Mean age of participants was 61 ± 10 years, 136 (49%) were women, mean BMI was 32 ± 9 kg/m2 and 85 (31%) had persistent AF. Mean iLAEAT was 0.82 ± 0.53 cm2/m2. Over 12-months, 109 (40%) had AF recurrence. Participants in the highest iLAEAT tertile were older, had higher CHA2DS2VASC scores, more likely to be male, have greater LA volume, and were more likely to have persistent (vs. paroxysmal) type AF than participants in the lowest iLAEAT tertile (p for all < 0.05). In regression analyses, iLAEAT was associated with higher odds of AF recurrence (OR = 2.93; 95% CI 1.34–6.43).Conclusions: iLAEAT can quantify LA adipose tissue burden using standard CT images. It is strongly associated with AF risk factors and outcomes, supporting the hypothesis that EAT plays a role in the pathophysiology of AF.

Epicardial Adipose Tissue in the Right Atrium Is Associated with Progression of Atrial Fibrillation and Recurrence after Pulmonary Vein Catheter Ablation in Patients with Atrial Fibrillation

“…The different technical protocols or procedures of CA may result in different cutoff values for atrial volume and atrial EAT volume in predicting AF recurrence. Our values of EAT volume were smaller than those of Sanghai et al 25 and Nagashima et al 2 , but the EAT volume may differ according to the machine accuracy of MDCT, the measurement method, the extent of measurement around the heart, and the time course of persistent AF 26 . However, the EAT volume in the present study was measured in a similar manner to the report by Shin et al 12 , and our values were similar to their values mean total heart EAT in patients with paroxysmal AF, 86 ml vs. 76.6 ml .…”

“…Sanghai et al 25 showed that a LA EAT volume＞0.95 cm 2 /body surface area m 2 using a 128-slice MDCT had a sensitivity of 45 and a specificity of 25.5 for predicting AF recurrence over 12 months of follow-up in patients with mixed AF. In a population of patients with mixed AF at a median follow-up time of 10.2 months, Nagashima et al 2 showed that a 320-slice MDCT LA EAT volume＞63.4 cm 3 was predictive of AF recurrence, with a sensitivity of 60.0 and a specificity of 96.0 .…”

The Association Between Diabetes Mellitus and Atrial Fibrillation: Clinical and Mechanistic Insights

“…Obesity is associated with increased thickness of epicardial adipose tissue (the fat that lies directly adjacent to the epicardium underneath the pericardium), which can have profound consequences on atrial electrophysiology and promote arrhythmogenesis (Abed et al, 2013; Mahajan et al, 2015; Evin et al, 2016). Indeed, increases in epicardial adipose tissue have been found to associate with adverse left atrial remodeling and increased incidence of AF, supporting the idea that epicardial adipose tissue could play an important role in the pathophysiology of AF (Sanghai et al, 2018). Coinciding with the increased epicardial adipose tissue volume, fatty infiltration of the atrial epicardium is also increased (Mahajan et al, 2015).…”

Micro-RNAs Are Related to Epicardial Adipose Tissue in Participants With Atrial Fibrillation: Data From the MiRhythm Study

“…Several groups, including ours, have shown correlation between EAT and onset as well as severity of AF. Our group has previously shown that an indexed measure of EAT surrounding the left atrium, called iLAEAT, is independently associated with the severity and recurrence of AF after catheter ablation (14).…”