Is There an Association between Epicardial Adipose Tissue and Outcomes after Paroxysmal Atrial Fibrillation Catheter Ablation?

Hammache, Néfissa; Pegorer-Sfes, Hugo; Bénali, Karim; Poull, Isabelle Magnin; Olivier, Arnaud; Echivard, Mathieu; Pace, Nathalie; Minois, Damien; Sadoul, Nicolas; Mandry, Damien; Sellal, Jean‐Marc; Chillou, Christian de

doi:10.3390/jcm10143037

Cited by 18 publications

(9 citation statements)

References 31 publications

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“…In a previously published cohort based on our center experience on 389 paroxysmal AF patients, we found a success rate of 67% at the one-year follow-up using CF RF catheters [13]. This is very close to our findings in the RF-matched cohort (72%) (sampled from this previous cohort), but lower than the rates described in the CLOSE or VISTAX studies where the reported rates were around 80% freedom of AF at 12 months [18].…”

Section: Efficacysupporting

confidence: 85%

“…For the RFA-matched cohort, a total of 417 patients who had a first RF paroxysmal AF ablation between April 2015 and December 2018 at Nancy University Hospital and a oneyear follow-up were screened from a previous database [13]. A 1:1 case-control matching with LB patients was then performed (on age, sex and indexed left atrial volume).…”

Section: Study Populationmentioning

confidence: 99%

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Efficacy and Safety of Second and Third-Generation Laser Balloon for Paroxysmal Atrial Fibrillation Ablation Compared to Radiofrequency Ablation: A Matched-Cohort

Guenancia

Hammache

Docq³

et al. 2021

JCDD

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Laser balloon (LB) has emerged as an interesting strategy for pulmonary vein isolation in paroxysmal atrial fibrillation (AF). A third-generation LB has recently been developed, allowing a continuous ablation set. We aimed to compare the results from our center’s experience with second and third-generation LBs to a cohort of matched patients who had undergone radiofrequency ablation (RFA) with contact-force catheters. This retrospective monocenter case-control study included our first 50 LB paroxysmal AF ablations (26 second and 24 third-generation LB) and 50 RFA controls, matched on age, sex and left atrial dilation. The two groups had similar baseline parameters. LB procedures were significantly shorter than RFA (129 (110–160) vs. 160 (119–198) min, p = 0.007). During AF ablation, two major complications occurred in each group. At the one-year follow-up, AF recurrence was diagnosed in 7 (14%) of the LB group vs. 14 (28%) of the RFA group (p = 0.14). Moreover, we observed that third-generation LB procedures were associated with shorter laser applications (22 (19–29) vs. 69 (55–76) min, p < 0.001) and procedural durations (111 (100–128) vs. 151.5 (128.5–167) min, p < 0.001) compared to second-generation LB procedures. In the context of the major increase in the number of AF ablations, LB demonstrated consistent results in terms of clinical success, complications and also reduced procedure durations compared to RFA.

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Section: Efficacysupporting

confidence: 85%

Section: Study Populationmentioning

confidence: 99%

Efficacy and Safety of Second and Third-Generation Laser Balloon for Paroxysmal Atrial Fibrillation Ablation Compared to Radiofrequency Ablation: A Matched-Cohort

Guenancia

Hammache

Docq³

et al. 2021

JCDD

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“…A recent systematic review and meta-analysis outlined the relationship between epicardial fat tissue imaged using echocardiography and CT with AF recurrence and found that total EAT volume, LA EAT volume, and epicardial fat thickness were associated with recurrence in patients undergoing AF ablation (14). Whereas a recent paper by Hammache et al suggested that, unlike individuals with persistent AF, EAT parameters in patients undergoing paroxysmal AF ablation are not associated with AF recurrence (23).…”

Section: Discussionmentioning

confidence: 92%

“…The average LA volume index was 54.2 [41. 23,67.51] mL/m 2 while the fibrosis burden was 16.9% [11.2, 24] of the LA wall. The median LA EAT volume was 34.65 [23.84, 47.73] mL while the median LA EAT index, adjusted to the body surface area (BSA), was 16.89 [12.24, 22.02] mL/m 2 .…”

Section: Resultsmentioning

confidence: 99%

MRI-quantified left atrial epicardial adipose tissue predicts atrial fibrillation recurrence following catheter ablation

Chahine

Macheret²,

Ordovás³

et al. 2022

Front. Cardiovasc. Med.

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BackgroundEpicardial adipose tissue (EAT) plays a significant role in promoting atrial fibrillation (AF) due to its proinflammatory properties and anatomic proximity to the myocardium. We sought to assess whether left atrial (LA) EAT volume is associated with AF recurrence following catheter ablation.MethodsEAT was assessed via the 3D MRI Dixon sequence in 101 patients undergoing AF ablation. Patients were followed for arrhythmia recurrence.ResultsDuring an average follow-up period of 1 year, post-ablation AF recurrence occurred in 31 (30.7%) patients. LA EAT index was higher in those with compared to without recurrence (20.7 [16.9, 30.4] vs. 13.7 [10.5, 20.1] mL/m2, p < 0.001), and so was LA volume index (66 [52.6, 77.5] vs. 49.9 [37.7, 61.8] mL/m2, p = 0.001). Cox regression analysis showed LA EAT (HR = 1.089; 95% CI: [1.049–1.131], p < 0.001) to be an independent predictor of post-ablation AF recurrence. The ROC curve for LA EAT index in the prediction of AF recurrence had an AUC of 0.77 (95% CI 0.68–0.86, p < 0.001) and showed an optimal cutoff value of 14.29 mL/m2 to identify patients at risk of post-ablation AF recurrence. Integrating LA EAT with clinical risk factors improved prediction of AF recurrence (AUC increased from 0.65 to 0.79, DeLong test p = 0.044). Kaplan-Meier analysis for recurrence-free survival showed a significant difference between two groups of patients identified by the optimal LA EAT index cutoff of 14.29 mL/m2 (log rank = 14.79; p < 0.001).ConclusionEAT quantified using cardiac MRI, a reproducible and widely accessible imaging parameter, is a strong and independent predictor of post-ablation AF recurrence.

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“…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 ). Traditionally AF ablation has used an endocardial approach to isolate the pulmonary veins.…”

Section: Implications For Treatment and Future Directionsmentioning

confidence: 99%

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

2023

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Epicardial adipose tissue (EAT) is an endocrine organ containing a host of cell types and undoubtedly serving a multitude of important physiologic functions. Aging and obesity cause hypertrophy of EAT. There is great interest in the possible connection between EAT and cardiovascular disease, in particular, atrial fibrillation (AF). Increased EAT is independently associated with AF and adverse events after AF ablation (e.g., recurrence of AF, and stroke). In general, the amount of EAT correlates with BMI or visceral adiposity. Yet on a molecular level, there are similarities and differences between epicardial and abdominal visceral adipocytes. In comparison to subcutaneous adipose tissue, both depots are enriched in inflammatory cells and chemokines, even in normal conditions. On the other hand, in comparison to visceral fat, epicardial adipocytes have an increased rate of fatty acid release, decreased size, and increased vascularity. Several studies have described an association between fibrosis of EAT and fibrosis of the underlying atrial myocardium. Others have discovered paracrine factors released from EAT that could possibly mediate this association. In addition to the adjacent atrial cardiomyocytes, EAT contains a robust stromal-vascular fraction and surrounds the ganglionic plexi of the cardiac autonomic nervous system (cANS). The importance of the cANS in the pathogenesis of atrial fibrillation is well known, and it is quite likely that there is feedback between EAT and the cANS. This complex interplay may be crucial to the maintenance of normal sinus rhythm or the development of atrial fibrillation. The extent the adipocyte is a microcosm of metabolic health in the individual patient may determine which is the predominant rhythm.

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Is There an Association between Epicardial Adipose Tissue and Outcomes after Paroxysmal Atrial Fibrillation Catheter Ablation?

Cited by 18 publications

References 31 publications

Efficacy and Safety of Second and Third-Generation Laser Balloon for Paroxysmal Atrial Fibrillation Ablation Compared to Radiofrequency Ablation: A Matched-Cohort

Efficacy and Safety of Second and Third-Generation Laser Balloon for Paroxysmal Atrial Fibrillation Ablation Compared to Radiofrequency Ablation: A Matched-Cohort

MRI-quantified left atrial epicardial adipose tissue predicts atrial fibrillation recurrence following catheter ablation

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

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