Abstract
ObjectivesEpicardial fat was closely related to atrial fibrillation (AF). Transthoracic echocardiography (TTE) has been proposed to be a convenient imaging tool in assessing epicardial adipose tissue (EAT). The goal of the present study was to investigate whether the EAT thickness measured on TTE was a useful parameter in predicting procedural outcomes of AF ablations.Methods and ResultsA total of 227 paroxysmal AF (PAF) and 56 non-paroxysmal AF (non-PAF) patients receiving catheter ablations from 2008-2010 were enrolled. Echocardiography-derived regional EAT thickness from parasternal long-axis view was quantified for each patient. Free of recurrence was defined as the absence of atrial arrhythmias without using antiarrhythmic agents after ablations. The mean EAT thickness of the study population was 6.1 ± 0.8 mm. Non-PAF patients had a thicker EAT than that of PAF patients (7.0 ± 0.7 mm versus 5.9 ± 0.7 mm, p value <0.001). During the follow-up of 16 ± 9 months, there were 95 patients (33.6%) suffering from recurrences of atrial arrhythmias. Non-PAF, chads2 score, left atrial diameter and EAT thickness were independent predictors of recurrence after catheter ablations. At a cutoff value of 6 mm for PAF and 6.9 mm for non-PAF, the measurement of EAT thickness could help us to identify patients at risk of recurrences.ConclusionsEAT thickness may serve as a useful parameter in predicting recurrences after AF ablations. Compared to other imaging modalities, TTE can be an alternative choice with less cost and time in assessing the effects of EAT on ablation outcomes.
Highlights
Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia and has been associated with a marked morbidity, mortality, and socioeconomic burden [1,2]
The main findings were as follows: (1) epicardial adipose tissue (EAT) thickness assessed by transthoracic echocardiography (TTE) was significantly correlated with the volumes of total and peri-atrial EATs measured by cardiac computed tomography (CT). (2) EAT was thicker in non-paroxysmal AF (PAF) than PAF patients, which suggested that EAT was associated with AF chronicity and may play a role in AF progression(3)
We demonstrated that EAT thickness assessed by TTE was significantly correlated with the volumes of total and peri-atrial EATs
Summary
Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia and has been associated with a marked morbidity, mortality, and socioeconomic burden [1,2]. Several recent studies have highlighted the close relationship between the amount of epicardial adipose tissue (EAT), presence of AF and recurrence of atrial arrhythmias after catheter ablation [4,5,6]. The measurement of the amount of EAT may provide useful information in managing AF patients, these imaging tools used before, such as cardiac computed tomography (CT) or magnetic resonance imaging (MRI), were expensive and subsequent processes of the images with off-line software were necessary to calculate fat volume. Lai et al further showed that TTE-based measurement of EAT thickness highly correlated with that measured on CT [10].
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