Association between epicardial adipose tissue density and outcomes after persistent atrial fibrillation catheter ablation

Abstract

Epicardial adipose tissue (EAT), through a paracrine secretion of various molecules, seems to be implicated in left atrial (LA) adverse remodelling, promoting persistent atrial fibrillation (PersAF). Computed tomography (CT) density appears to be a marker of EAT secretory activity. We sought to assess whether EAT density alone or combined with EAT volume is associated with the occurrence of PersAF after a first catheter ablation (CA) procedure. This retrospective study included all consecutive patients undergoing a first CA procedure for PersAF in Nancy University Hospital in 2016 and 2017 with a one-year follow-up. Cardiac CT performed before the ablation allowed quantitative (volume) and qualitative (density) analysis of EAT. One hundred and seventy-seven patients were included. After adjustment, determinants of EAT volume were age (β = 0.97, P = 0.014), triglycerides level (β = 10.61, P = 0.002), LA area (β = 4.06, P < 0.001), and LA volume (β = −1.05, P = 0.005). Overall EAT density was associated with increased BMI (β=0.19, P = 0.005) and BNP level (β = 0.002, P = 0.005), while peri-LA EAT density correlated with higher BMI (β = 0.37, P = 0.01) and total cholesterol level (β = 2.53, P = 0.017). Patients showing AF recurrence were more likely to be females (30.2% vs. 14.8%, P = 0.016), diabetics (21.9% vs. 9.9%, P = 0.032) and symptomatic (NYHA III/IV: 20.8% vs. 8.6%, P = 0.025). AF recurrence was associated with a lower density of overall EAT (−97.7 ± 4.4 vs. −96.3 ± 3.9, P = 0.024) and peri-LA EAT (P < 0.001). EAT density assessed by cardiac CT seems to be correlated with the risk of recurrence after a first PersAF CA. EAT density might be useful to predict PersAF recurrence after CA and could also become a therapeutic target.