Abstract
AimsThis study aimed to determine the impact of the volume of epicardial fat on the duration of radiofrequency (RF) energy delivery during the procedure of ablation of atrial fibrillation (AF). MethodsThe volume of epicardial fat was measured from spiral computerized tomography scan. The primary endpoint was the duration of RF delivery for pulmonary vein isolation (PVI), and the overall total duration of RF application. Secondary endpoint was conversion of AF to sinus rhythm or organisation of the arrhythmia after PVI. ResultsFrom March 2015 to May 2018, 222 patients (45.5% with persistent AF) underwent a first RF catheter ablation procedure for AF. The total duration of RF delivery, and the duration of RF delivery specifically for PVI were significantly associated with higher total volume of epicardial fat (p = 0.0002; p = 0.009 respectively), periatrial (p = 0.003; p = 0.045) and periventricular epicardial fat (p = 0.001; p = 0.012). In multivariate analysis, total epicardial fat volume was not significantly associated with total RF delivery duration (p = 0.743). For patients with arrhythmia at the time of the procedure, patients who achieved conversion or organisation of their arrhythmia after PVI had similar levels of total epicardial fat to those whose arrhythmia persisted (65 ± 35.2 vs 74.5 ± 31.2 ml; p = 0.192). ConclusionWe observed a significant relation between total, periatrial, and periventricular epicardial fat, and the duration of RF delivery during ablation of AF. This relation was not significant by multivariate analysis meaning that epicardial fat may be a marker, but not an independent factor, of ablation complexity.
Highlights
Atrial fibrillation (AF) is a heart rhythm disorder that affects around one quarter of adults in developed countries, and 600,000 patients in France
Catheter ablation of AF is a therapy indicated when antiarrhythmic drugs fail in patients with paroxysmal or persistent AF who remain symptomatic according to the European Heart Rhythm Association symptom scale (Grade 1A recommendation) [1]
Our study found a significant relationship between the volume of total, periatrial, and periventricular epicardial fat, and the duration of RF energy delivery during catheter ablation of AF
Summary
Atrial fibrillation (AF) is a heart rhythm disorder that affects around one quarter of adults in developed countries, and 600,000 patients in France. Catheter ablation of AF is a therapy indicated when antiarrhythmic drugs fail in patients with paroxysmal or persistent AF who remain symptomatic according to the European Heart Rhythm Association symptom scale (Grade 1A recommendation) [1]. It can be considered as first line therapy as an alternative to antiarrhythmic drugs, in selected patients with symptomatic. Recent studies have widened the indication for catheter ablation of AF, notably to heart failure patients further to the CASTLE-AF study [2]
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