Left Atrial Epicardial Adipose Tissue Research Articles

Segmental evaluation of predictive value of left atrial epicardial adipose tissue following catheter ablation for atrial fibrillation

BackgroundLeft atrial epicardial adipose tissue (LA-EAT) is associated with the recurrence of atrial tachyarrhythmias (AF/AT) after catheter ablation for atrial fibrillation (AF). However, no previous studies have assessed the predictive value of segment-specific LA-EAT volumes for AF/AT recurrence. This study aimed to assess the relationship between segmental LA-EAT volume and AF/AT recurrence. MethodsThis study included 350 consecutive patients who underwent initial AF ablation (53.7 % paroxysmal AF (PAF)). Preoperative multidetector row computed tomography assessed LA-EAT, categorized into three segments: anterior-EAT, posterior-EAT, and interatrial septal adipose tissue (IAS-AT). ResultsDuring a mean follow-up period of 351 ± 109 days, 56 patients (16.0 %) experienced AF/AT recurrence. The mean LA-EAT volume was 20.7 ± 11.1 ml and LA-EAT ≥26.8 ml was an independent risk factor for AF/AT recurrence (HR 2.21, 95 % confidence interval (CI): 1.24–3.93, P = 0.007). Receiver operating characteristic analyses revealed the area under the curve for IAS-AT was 0.669 (95 % CI: 0.596–0.743) with an optimal cut-off point of 1.3 ml (sensitivity 76.8 %; specificity 50.0 %), significantly outperforming the anterior- and posterior-EAT in predicting recurrent AF/AT. Multivariate analysis indicated IAS-AT was an independent predictor of AF/AT recurrence in patients with persistent AF (PeAF) (HR 3.52, 95 % CI: 1.52–8.13, P = 0.003), but not in patients with PAF. ConclusionsLA-EAT predicts AF/AT recurrence after AF ablation, with IAS-AT proving significantly more effective than other LA-EAT segments in predicting recurrence. Notably, IAS-AT emerged as an independent predictor of AF/AT recurrence in patients with PeAF but not in those with PAF.

Association between Epicardial Adipose Tissue and Atrial Fibrillation in Patients with Transfusion-Dependent β-Thalassemia.

Background: Modern treatments for transfusion-dependent β-thalassemia (TDβT) have allowed patients to reach high life expectancy with no iron overload. Despite survival improvement, atrial fibrillation (AF) has emerged as a relevant issue. AF pathophysiology and characteristics in TDβT are different than in the general population. Epicardial adipose tissue (EAT) may play a role but its relationship with AF in patients with TDβT has not been explored. Methods: A monocentric, cross-sectional study, enrolling consecutive patients with TDβT. Epicardial adipose tissue (EAT) was evaluated at magnetic resonance. Characteristics of patients with and without history of AF were investigated. Factors independently associated with AF prevalence were analyzed. Results: A total of 116 patients were enrolled. All patients were treated with regular chelation therapy. The prevalence of AF was 29.3% (34/116). Cardiac T2* and liver iron concentration were no different between patients with and without AF. EAT thickness was significantly higher in patients with AF at left atrium, right atrium and right ventricle (5.0 vs. 4.0 mm, p < 0.01, 4.4 vs. 4.0, p = 0.02 and 5.0 vs. 4.3, p = 0.04). Patients with AF presented with older age, (53 vs. 49 years, p < 0.01), more hypothyroidism (44.1 vs. 20.7%, p = 0.01), pulmonary hypertension (23.5 vs. 2.4% p < 0.01), splenectomy (88.2 vs. 64.6%, p = 0.01), higher right and left atrial volume (61 vs. 40 and 74 vs. 43 mL, both p < 0.01). At multivariable analysis, hypothyroidism, left atrial volume and left atrial EAT were independently associated with AF (odds ratio 9.95, 1.09 and 1.91, respectively). Conclusions: In a contemporary cohort of patients with TDβT, treated with regular chelation therapy, prevalence of AF was unrelated to iron overload. EAT was independently associated with AF.

The Relationship Between Cardiac CT-based Left Atrial Structure and Epicardial Adipose Tissue and Postablation Atrial Fibrillation Recurrence Within 2 Years.

The aim of this study was to explore the association of cardiac CT-based left atrium (LA) structural and functional parameters and left atrial epicardial adipose tissue (LA-EAT) parameters with postablation atrial fibrillation (AF) recurrence within 2 years. Contrast-enhanced cardiac CT images of 286 consecutive AF patients (median age: 65 y; 97 females) who underwent initial ablation between June 2018 and June 2020 were retrospectively analyzed. Structural and functional parameters of LA, including maximum and minimum volume and ejection fraction of LA and left atrial appendage (LAA), and LA-EAT volume, were measured. The body surface area indexed maximum and minimum volume of LA (LAVImax, LAVImin) and LAA (LAAVImax, LAAVImin), and LA-EAT volume index (LA-EATVI) were calculated. Independent predictors of AF recurrence were determined using Cox regression analysis. The clinical predictors were added to the imaging predictors to build a combined model (clinical+imaging). The predictive performance of the clinical, imaging, and combined models was assessed using the area under the receiver operating characteristics curve (AUC). A total of 108 (37.8%) patients recurred AF within 2 years after ablation at a median follow-up of 24 months (IQR=11, 32). LA and LAA size and LA-EAT volume were significantly increased in patients with AF recurrence (P<0.05). After the multivariable regression analysis, LA-EATVI, LAAVImax, female sex, AF duration, and stroke history were independent predictors for AF recurrence. The combined model exhibited superior predictive performance compare to the clinical model (AUC=0.712 vs. 0.641, P=0.023) and the imaging model (AUC=0.712 vs. 0.663, P=0.018). Cardiac CT-based LA-EATVI and LAAVImax are independent predictors for postablation AF recurrence within 2 years and may provide a complementary value for AF recurrence risk assessment.

Associations between atrial epicardial fat quantified by semi-automated CT segmentation and gender, BMI, cholesterol levels in AF patients: results from the prospective AFAT study

Abstract Background Epicardial adipose tissue (EAT) is defined as adipose tissue (epicardial fat) between the myocardium and the visceral pericardium. Recent evidence suggests that EAT may play important roles in regard to atrial fibrillation (AF) burden as well as other cardiovascular diseases through complex inflammatory mechanisms. Current evidence regarding the relationship of atrial EAT and BMI, gender or cardiovascular risk factors is mixed. Methods and Results We conducted a prospective observational study (AFAT) at the German Heart centre in Munich with 200 patients aimed to be included. This represents an interim analysis of the first 75 patients enrolled in the AFAT study. All patients received delayed dual source cardiac computer tomography (CT) imaging which was analysed using 3D segmentation (Figure 1) to quantify left atrial (LA) and right atrial (RA) EAT prior to receiving catheter ablation for AF. The mean age was 67 ± 8.7 years with 46.9 % being female (n=35) and the mean BMI was 28 ± 4.5. Mean LA EAT was 33.1 ml ± 13.2 ml and RA EAT was 32.7 ml ± 12.2ml with a total mean atrial EAT volume of 65.4 ml ± 10.2 ml. Volumes of the left- and right atrial EAT were significantly correlated in our sample (p &amp;lt; 0.001; Pearson correlation coefficient r=0.9). The mean total EAT Volume was significantly larger in males than in females (74 ml vs. 52 ml, p &amp;lt; 0.001) (Figure 2). Linear regression analysis adjusted for cofounders demonstrated significantly larger mean atrial EAT volumes in patients with higher body mass index (p = 0.001) and with increased age (p=0.006). Increased HbA1c levels or increased total cholesterol levels were not associated with higher total atrial EAT Levels (respectively, p=0.066 and p=0.22). Conclusion Semi-automated CT based atrial segmentation is a novel highly accurate and reproducible way to reliably identify atrial EAT. Left and right atrial EAT volumes are significantly intercorrelated. In this study BMI, Age and male gender were independently associated with higher EAT levels.Visualization of atrial EATGender differences in atrial EAT (ml)

Volumetric quantification of epicardial fat using semiautomated atrial CT segmentation in patients with atrial fibrillation: the Prospective AFAT study

Abstract Background Epicardial fat or epicardial adipose tissue (EAT) is most commonly defined as adipose tissue between the myocardium and the visceral pericardium. Previous studies have suggested EAT to be an important contributor to the pathogenesis of atrial fibrillation (AF) as well as a plausible predictor for AF recurrences after ablation. However, data on EAT using precise volumetric quantification is limited. Methods and Results AFAT is a prospective observational study conducted at a heart centre in our city with 200 patients aimed to be included. We conducted an interim analysis of the first 75 patients enrolled in the AFAT study. All patients received delayed dual source cardiac computer tomography (CT) imaging which was analysed using semi-automated 3D segmentation (Figure 2) to quantify left atrial (LA) and right atrial (RA) EAT prior to ablation (52.5 % persistent AF). The mean age was 67 ± 8.7 years with 46.9 % (n=35) being female. Mean BMI was 28 ± 4.5. The Mean LA EAT was 33.1 ml ± 13.2 ml and RA EAT was 32.7 ml ± 12.2ml. Median follow up after AF catheter ablation was 163 days. The optimal cut point for the total atrial EAT was estimated at 50.2 ml. In patients with total atrial EAT ≤ 50 ml recurrence of any atrial arrythmia after catheter ablation occurred in 8% (6 patients) compared to 25.3% (19 patients) recurrence rates in patients with a total atrial EAT &amp;gt; 50 ml. Kaplan-Meyer estimates showed no statistical difference between groups (log rank p=0.063) as this analysis is under-powered with more patients being enrolled for the final results (Figure 1). Conclusion The use of semi-automated CT based atrial segmentation presents a novel highly accurate and reproducible method to reliably identify atrial EAT. Increased atrial EAT is likely to play an important role for arrythmia recurrences after catheter ablation. Final results of the AFAT study will provide further evidence to this important subject.Arrhythmia recurrences depending on EATBiatrial 3D Segmentation of EAT

Epicardial Atrial Fat at Cardiac Magnetic Resonance Imaging and AF Recurrence after Transcatheter Ablation.

The relationship between epicardial adipose tissue (EAT) and atrial fibrillation (AF) has gained interest in recent years. The previous literature on the topic presents great heterogeneity, focusing especially on computed tomography imaging. The aim of the present study is to determine whether an increased volume of left atrial (LA) EAT evaluated at routine pre-procedural cardiac magnetic resonance imaging (MRI) relates to AF recurrences after catheter ablation. A total of 50 patients undergoing AF cryoballoon ablation and pre-procedural cardiac MRI allowing quantification of LA EAT were enrolled. In one patient, the segmentation of LA EAT could not be achieved. After a median follow-up of 16.0 months, AF recurrences occurred in 17 patients (34%). The absolute volume of EAT was not different in patients with and without AF recurrences (10.35 mL vs. 10.29 mL; p-value = 0.963), whereas the volume of EAT indexed on the LA volume (EATi) was lower, albeit non-statistically significant, in patients free from arrhythmias (12.77% vs. 14.06%; p-value = 0.467). The receiver operating characteristic curve testing the ability of LA EATi to predict AF recurrence after catheter ablation showed sub-optimal performance (AUC: 0.588). The finest identified cut-off of LA EATi was 10.65%, achieving a sensitivity of 0.5, a specificity of 0.82, a positive predictive value of 0.59 and a negative predictive value of 0.76. Patients with values of LA EATi lower than 10.65% showed greater survival, free from arrhythmias, than patients with values above this cut-off (84% vs. 48%; p-value = 0.04). In conclusion, EAT volume indexed on the LA volume evaluated at cardiac MRI emerges as a possible independent predictor of arrhythmia recurrence after AF cryoballoon ablation. Nevertheless, prospective studies are needed to confirm this finding and eventually sustain routine EAT evaluation in the management of patients undergoing AF catheter ablation.

Epicardial fat and left atrial appendage thrombosis in patients with persistent atrial fibrillation

BACKGROUND: Excessive deposition of the epicardial adipose tissue (EAT) plays a role in the development of a number of cardiovascular diseases, including ischemic stroke. As more than half of strokes in patients with atrial fibrillation (AF) are cardioembolic, and the source of thromboembolic complications is the left atrial appendage (LAA), it can be assumed that excess EAT contributes to the development of LAA thrombus. The literature does not present the results of a study of the relationship between the amount of EAT and LAA thrombus in patients with AF, which makes it relevant to study this issue.AIM: to study the effect of EAТ on LAA thrombosis and the emptying flow velocity from the LAA in patients with persistent AF.MATERIALS AND METHODS: The patients with persistent AF underwent transesophageal and transthoracic echocardiography before the planned cardioversion. The transesophageal echocardiography measured the emptying flow velocity from the LAA, and the thickness of the interatrial septum and the left lateral ridge, the average value of which was used to estimate the amount of left atrial EAT. The thickness of the anterior wall of the right ventricular EAT was measured by transthoracic echocardiography.RESULTS: The LAA thrombus was detected in 42 (8.6%) patients of 486 patients with persistent AF (age 64.0 [59.0; 70.0] years, men 58.0%). Patients with thrombus had greater thickness of the left atrial EAT (9.30 [9.05; 9.55] vs. 7.70 [7.03; 8.28] mm, p&lt;0.001) and of the right ventricular EAT (8.05 [7, 90; 8.90] versus 7.80 [7.20; 8.40] mm, p = 0.001), but the emptying flow velocity from the LAA is lower (20.0 [14.0; 26.0] versus 32.0 [26.0; 39.0] cm/s, p&lt;0.001). Area under the receiver operator characteristic curve for the thickness of the left atrial EAT, as a predictor of the LAA thrombosis, was significantly larger than for the thickness of the right ventricular EAT: 0.947 (0.923–0.965) versus 0.661 (0.617–0.703), p&lt;0.001. The thickness of the left atrial EAT more than 8.6 mm increases the chances of LAA thrombosis by 70.1 (24.1–204.2) times. Analysis of multiple linear regression did not reveal an independent effect of the thickness of the left atrial EAT (b = -0.0951±0.6163, p = 0.877) and of the right ventricular EAT (b = 0.6764±0.4383, p = 0.124) on the emptying flow velocity from the LAA.CONCLUSION: The increased of the thickness of EAT increases the chances of developing LAA thrombosis in patients with persistent AF, but does not affect on the emptying flow velocity from the LAA.

Understanding the impact of left atrial epicardial adipose tissue thickness on atrial fibrillation: A literature review

Understanding the impact of left atrial epicardial adipose tissue thickness on atrial fibrillation: A literature review

Epicardial adipose tissue dispersion at CT and recurrent atrial fibrillation after pulmonary vein isolation

ObjectivesEpicardial adipose tissue (EAT) remodeling is associated with atrial fibrillation (AF). Left atrial (LA) EAT dispersion on cardiac CT is a non-invasive imaging biomarker reflecting EAT heterogeneity. We aimed to investigate the association of LA EAT dispersion with AF recurrence after pulmonary vein isolation (PVI).MethodsIn a prospective registry of consecutive patients undergoing first PVI, mean EAT attenuation values were measured on contrast-enhanced cardiac CT scans in Hounsfield units (HU) within low (− 195 to − 45 HU) and high (− 44 to − 15 HU) threshold EAT compartments around the left atrium (LA). EAT dispersion was defined as the difference between the mean HU values within the two EAT compartments. Continuous variables were compared between groups using the Mann–Whitney U test and cox proportional hazard models were used to calculate hazard ratios of predictors of 1-year AF recurrence.ResultsA total of 208 patients were included, 135 with paroxysmal AF and 73 with persistent AF. LA EAT dispersion was significantly larger in patients with persistent compared to paroxysmal AF (52.6 HU vs. 49.9 HU; p = 0.001). After 1 year of follow-up, LA EAT dispersion above the mean (> 50.8 HU) was associated with a higher risk of AF recurrence (HR 2.3, 95% CI 1.5–3.6; p < 0.001). It retained its predictive value when corrected for age, sex, body mass index, LA volume, and AF type (HR 2.8, 95% CI 1.6–4.6; p < 0.001).ConclusionA larger LA EAT dispersion on contrast-enhanced cardiac CT scans, reflecting EAT heterogeneity, is independently associated with AF recurrence after PVI.Clinical relevance statementBased on LA EAT dispersion assessment, a more accurate risk stratification and patient selection may be possible based on a pre-procedural cardiac CT when planning PVI.Key Points• Epicardial adipose tissue (EAT) remodeling is associated with atrial fibrillation (AF).• A larger left atrial EAT dispersion in a pre-procedural cardiac CT was associated with a higher 1-year AF recurrence risk after pulmonary vein isolation.• A pre-procedural cardiac CT with left atrial EAT dispersion assessment may provide a more accurate risk stratification and patient selection for PVI.

Kiosk 3R-FB-07 - The Spatial Overlap Between Left Atrial Epicardial Adipose Tissue and Fibrosis Is Not Associated to Clinical Stage of Atrial Fibrillation

Kiosk 3R-FB-07 - The Spatial Overlap Between Left Atrial Epicardial Adipose Tissue and Fibrosis Is Not Associated to Clinical Stage of Atrial Fibrillation

Abstract 14853: Effects of Yearlong High Intensity Aerobic Exercise on Reducing Left Atrial Epicardial Adipose Tissue

Background: Left atrial epicardial adipose tissue (LA EAT) is often elevated in patients with heart failure and has been linked to abnormal atrial function and increased risk for atrial fibrillation. Whether LA EAT is potentially modifiable is unknown. We tested the hypothesis that one year of high intensity interval training (HIIT) would reduce LA EAT area and in turn be associated with improved atrial function in an obese cohort at risk for developing heart failure with preserved ejection fraction (HFpEF). Methods: Middle-aged obese adults (n = 80, age 40-55 yrs) enriched for increased HFpEF risk (N-terminal pro-B-type natriuretic peptide &amp;gt;40 pg/mL or high-sensitivity cardiac troponin T &amp;gt;0.6 pg/mL; visceral fat &amp;gt;2kg) were randomized to one year of HIIT or attention control. Outcome variables included LA EAT area and LA strain. LA EAT area was quantified through tracings of anterior, posterior, and lateral EAT depots in long axis views on cardiac MRI. LA strain was measured with MRI feature tracking as reservoir strain during left ventricular (LV) systole, conduit strain during early LV diastole, and contractile strain during late LV diastole. Results: Fifty-three participants completed the study. There was no difference in LA EAT area after one year in either the HIIT group (n = 26) or controls (n = 27); difference in mean = -0.17 cm 2 , 95% CI = -0.93 to 0.59, p = 0.66. However, amongst all participants, reduction in LA EAT was associated with improvement in LA reservoir strain (r = -0.50, 95% CI = -0.68 to -0.26, p &amp;lt; 0.001) and LA conduit strain (r = 0.51, 95% CI = 0.27 to 0.68, p &amp;lt; 0.001) but not LA contractile strain (r = 0.15, 95% CI = -0.13 to 0.40, p = 0.298). Conclusions: One year of HIIT did not reduce LA EAT in at-risk obese patients. However, regardless of assignment, decreased LA EAT was associated with improved LA reservoir and conduit strain, suggesting efforts to reduce LA EAT may improve LA function in at-risk obese patients.

Quantification of epicardial adipose tissue by computed tomographic scanning as a prognostic criterion of atrial fibrillation recurrence after catheter ablation.

Aim This study focused on a systematic review and meta-analysis on the predictive role of quantifying the epicardial adipose tissue (EAT) volume using data of computed tomography (CT) in patients after catheter ablation for atrial fibrillation (AF).Material and methods We performed a search in PubMed and Google Scholar for studies that examined the predictive value of EAT volume measured by CT for AF recurrence in patients after undergoing pulmonary venous isolation. Risk ratio (RR) values from studies, where similar scoring criteria were available, were pooled for the meta-analysis.Results Eighteen studies were selected from 901 publications for these systematic review and meta-analysis. In total, 4087 patients were included in this analysis (mean age, 59.0 years; mean follow-up duration, 14.9 mos). Patients with recurrent AF after ablation had higher left atrial EAT volume compared to patients without relapse (weighted mean difference, 5.99 ml; 95% CI: -10.04 to -1.94; p = 0.004). An increase in left atrial EAT volume per ml was significantly associated with the development of AF recurrence after ablation (RR 1.08; 95% CI: 1.01 to 1.16; p=0.03). Patients with recurrent AF after ablation also had higher total EAT values than patients without relapse (difference in weighted values, 11.67 ml; 95% CI: -19.81 to -3.54; p = 0.005). However, no significant association was found between the total EAT volume and the risk of AF relapse (RR 1.00; 95% CI: 1.00 to 1.01; p=0.06).Conclusions The volume of left atrial EAT measured by CT has a significant predictive value in AF patients after catheter ablation and can be used for stratification of the risk for recurrent AF.

Epicardial adiposity in people with atrial fibrillation modified by physical exercise: an umbrella review

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Atrial Fibrillation (AF) affects 30% of the world’s population and accounts for 3 million deaths annually, and current management pathways often result in poor outcomes in recurrence of AF with up to 50% reoccurring post pulmonary vein isolation cardiac ablation (PVICA). Epicardial Adipose Tissue (EAT) is a metabolically active substrate implicated in the pathogenesis of AF. Increased levels of EAT thickness have been associated with the risk of developing AF and has also been associated with poorer outcomes and increased likelihood of AF recurrence after PVICA. The aim of this work was to explore current knowledge on levels of EAT in people with AF, post cardiac ablation, taking account of physical activity (PA). Objectives: Three research questions were set: · Does volume of EAT contribute to the pathogenesis and severity of AF? · Does any kind of PA modify EAT volumes? · Does PA improve outcomes in patients with AF who have undergone PVICA? Methods An umbrella review format was adopted with eligible studies from PubMed, EMBASE, the Cochrane Central Register of controlled trials (CENTRAL), Ovid MEDLINE, CINAHL, and Scopus and registered on Prospero. All results were reported adhering to Preferred Reporting items for Systematic Reviews and Meta-Analysis (PRISMA). Quality assessment evaluation involved the AMSTAR 2 tool and risk of bias evaluated using the ROBIS tool. No ethical considerations were identified for this review. Results Ten reviews were eligible for inclusion in the analysis. Five examined the relationship between EAT and AF occurrence, three examined EAT modifications with PA and two examined the effect of PA on AF outcomes. The quality of the studies was high, with a low risk of bias. Increased EAT volumes were associated with a large effect size for the development of AF Hedges’ g=0.86[0.79,0.92] for Total EAT volume and g=1.31[1.16,1.47] for Left Atrial (LA) EAT volume, and AF severity also had a large effect size for both Total and LA EAT volumes with g=0.87[0.71,1.02] and 0.99[0.69,1.3] respectively. EAT also showed a large effect on recurrence of AF post PVICA in both the Total and LA EAT groups 1.15[0.88,1.43] and 0.92[0.65,1.2]. The overall impact of PA showed a small to medium effect in reducing EAT volumes g=0.23[0,0.46]. Despite this PA was shown to significantly improve outcomes in reducing AF frequency, duration and severity and risk of mortality and serious adverse events in the intervention groups Conclusion Higher levels of EAT are associated with AF after PVICA but the influence of PA is unclear. This review highlights the need for further research evaluating the impact that physical activity has on EAT volume reduction and recurrence of AF post PVICA.

Left atrial epicardial adipose tissue exacerbates electrical conduction disturbance in normal-weight patients undergoing pulmonary vein isolation for atrial fibrillation.

Epicardial adipose tissue (EAT) exacerbates both electrical and structural remodeling in obese atrial fibrillation (AF) patients, but the impacts of EAT on atrial arrhythmogenicity remain unclear in normal-weight AF patients. Therefore, we sought to investigate this issue using electroanatomic mapping. We enrolled drug-refractory 105 paroxysmal AF patients in the normal body mass index range (18.5-24.9 kg/m2 ), who had undergone electroanatomic mapping after pulmonary vein isolation (PVI). One day before PVI, we assessed P-wave duration in a 12-lead electrocardiogram and left atrial (LA)-EAT volumes using contrast-enhanced computed tomography. The patients were divided into two groups based on the median LA-EAT volume (16.0 ml); the high LA-EAT group (≥16.0 ml, n = 53) and low LA-EAT group (<16.0 ml, n = 52). We compared P-wave duration, LA conduction velocity and bipolar voltage, the presence of low-voltage zone (<0.5 mV), and LA volume index on echocardiography between the two groups. The LA bipolar voltage, low-voltage zone, and LA volume index were not different between the high and low LA-EAT groups. However, P-wave duration was significantly longer in the high group than in the low group (p < .001). Additionally, the LA conduction velocity was significantly more depressed in the high group than in the low group (p < .001). Multivariate linear regression analysis revealed that LA-EAT volume was correlated with P-wave duration (β = .367, p < .001) and conduction velocity (β = -.566, p < .001), respectively. Increased LA-EAT volumes were associated with electrical conduction disturbance after PVI in normal-weight patients with AF. P-wave duration may be a clinically useful predictor of LA-EAT.

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

Epicardial 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. EAT was assessed via the 3D MRI Dixon sequence in 101 patients undergoing AF ablation. Patients were followed for arrhythmia recurrence. During 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). EAT quantified using cardiac MRI, a reproducible and widely accessible imaging parameter, is a strong and independent predictor of post-ablation AF recurrence.

Abstract 10850: Epicardial Adipose Tissue is Associated With Left Atrial Volume and Fibrosis in Patients With Atrial Fibrillation

Background : Obesity is a risk factor for atrial fibrillation (AF) and strongly influences response to treatment. Atrial fibrosis shows similar associations. Epicardial adipose tissue (EAT) may be a link between these associations. We sought to assess whether EAT is associated with body mass index (BMI), left atrial (LA) volume and fibrosis. Methods: LA fibrosis and EAT were assessed using Late Gadolinium Enhancement, and Dixon MRI sequences, respectively. We derived 3D models incorporating fibrosis and EAT to assess spatial colocalization: we measured the distance of fibrotic and non-fibrotic areas to the nearest EAT, and calculated the volume of EAT within a radius of 5 mm for every LA surface point. Results: 103 AF patients (64% paroxysmal, 73% male) were analyzed. LA volume index was 54.9 [41.2, 69.7] mL/m 2 , LA EAT index was 17.4 [12.7, 22.9] mL/m 2 , and LA fibrosis was 17.1 [12.4, 23.1] %. LA EAT was significantly correlated with BMI (R=0.557, p&lt;0.001); as well as with LA volume and LA fibrosis after BSA adjustment (R=0.579 and R=0.432 respectively, p&lt;0.001 for both) (Panel A). Multivariable analysis showed LA EAT to be independently associated with LA volume and fibrosis. Aggregation of local EAT proximity values in all models revealed that the minimum distance to fat was significantly greater for fibrotic LA surface regions compared to non-fibrotic areas (6.97 mm [3.28, 12.13] vs 5.71 mm [2.58, 10.35], p&lt;0.001) (Panel C). The proportion of LA surface points having fat within a radius of 5 mm was greater for non-fibrotic compared to fibrotic regions (37.6% [23.4, 48] vs 41.6% [31.2, 58.1] respectively, p=0.021). Thus, 3D registration of fat and fibrosis around the LA showed no clear spatial overlap between EAT and fibrotic LA regions (Panel B). Conclusion: LA EAT is associated with obesity (BMI) as well as LA volume and fibrosis. Regions of LA EAT are not colocalized with fibrotic areas, suggesting a systemic or paracrine mechanism rather than EAT infiltration of fibrotic areas.

Abstract 10880: Left Atrial Epicardial Adipose Tissue Predicts Atrial Fibrillation Recurrence Following Catheter Ablation

Introduction: Atrial fibrillation (AF) recurrence following catheter ablation (CA) remains high. Epicardial adipose tissue (EAT) is increasingly recognized for its significant role in promoting AF arrhythmogenesis 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 CA. Methods: EAT was assessed via cardiac MRI using a 3D Dixon sequence (Panel A) in 101 patients undergoing radiofrequency or cryoballoon CA for AF. Patients were followed for AF recurrence. Results: During an average follow-up period of 300 days, post ablation AF recurrence occurred in 31 (30.7%) patients. The median time for AF recurrence following CA was 136 days. LA EAT index was higher in those with recurrence (20.7 [16.9, 30.4] vs 13.7 [10.5, 20.1] mL/m 2 , p &lt; 0.001), and so was LA volume index (66.6 [53.8, 77.5] vs 49.9 [37.7, 62.8] mL/m 2 , p &lt; 0.001). 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&lt;0.001) and showed an optimal cutoff value of 14.29 mL/m 2 to identify patients at risk of AF recurrence post ablation (Youden’s J statistic = 0.446). Integrating LA EAT with clinical risk factors (age, BMI, AF type and hypertension) provided a better discriminatory performance in predicting AF recurrence than clinical risk factors alone (AUC 0.79 vs 0.65, DeLong test p = 0.044) (Panel B). Cox regression analysis showed LA EAT (HR: 1.088; 95% CI: [1.047-1.13], p &lt;0.001) to be an independent predictor of post ablation AF recurrence. The Kaplan-Meier curve for recurrence free survival showed a significant difference between 2 groups of patients identified by the optimal LA EAT index cut-off of 14.29 mL/m 2 (log rank = 14.79; p &lt; 0.001) (Panel C). Conclusion: EAT quantified using cardiac MRI, a reproducible and widely accessible imaging parameter, is a strong and independent predictor of AF recurrence following CA.

Epicardial adipose tissue is associated with left atrial volume and fibrosis in patients with atrial fibrillation.

Obesity is a risk factor for atrial fibrillation (AF) and strongly influences the response to treatment. Atrial fibrosis shows similar associations. Epicardial adipose tissue (EAT) may be a link between these associations. We sought to assess whether EAT is associated with body mass index (BMI), left atrial (LA) fibrosis and volume. LA fibrosis and EAT were assessed using late gadolinium enhancement, and Dixon MRI sequences, respectively. We derived 3D models incorporating fibrosis and EAT, then measured the distance of fibrotic and non-fibrotic areas to the nearest EAT to assess spatial colocalization. One hundred and three AF patients (64% paroxysmal, 27% female) were analyzed. LA volume index was 54.9 (41.2, 69.7) mL/m2, LA EAT index was 17.4 (12.7, 22.9) mL/m2, and LA fibrosis was 17.1 (12.4, 23.1)%. LA EAT was significantly correlated with BMI (R = 0.557, p < 0.001); as well as with LA volume and LA fibrosis after BSA adjustment (R = 0.579 and R = 0.432, respectively, p < 0.001 for both). Multivariable analysis showed LA EAT to be independently associated with LA volume and fibrosis. 3D registration of fat and fibrosis around the LA showed no clear spatial overlap between EAT and fibrotic LA regions. LA EAT is associated with obesity (BMI) as well as LA volume and fibrosis. Regions of LA EAT did not colocalize with fibrotic areas, suggesting a systemic or paracrine mechanism rather than EAT infiltration of fibrotic areas.

Left atrial epicardial adipose tissue is associated with low voltage zones in the left atrium in patients with non-valvular atrial fibrillation.

ObjectiveEpicardial adipose tissue (EAT) is related to atrial fibrillation (AF), but the specific mechanism is still unclear. Left atrial (LA) low voltage zones (LVZ) can well reflect atrial fibrosis. This study investigated the relationship between EAT and LVZ in non-valvular AF (NVAF) patients.MethodsThis observational study including patients with NVAF (n = 214) undergoing radiofrequency ablation (RFCA) for the first time in our hospital and 62 matched controls. The EAT volume and attenuation were measured by contrast-enhanced computed tomography. A three-dimensional mapping system was used to map the left atrial endocardium and evaluate LA-LVZ. Patients were divided into LVZ and non-LVZ groups according to the presence or absence of LVZ.ResultsPatients with AF showed higher LA-EAT volume and lower attenuation value than controls (29.7 ± 11.2 cm3 vs. 20.9 ± 8.6 cm3, P = 0.021; −91.2 ± 5.6 HU vs. −88.7 ± 5.9 HU, P < 0.001). Compared with the group without LVZ, there were significant differences in age [65 (59–71) vs. 60 (52–69), P = 0.006], LAVI [75.1 ± 20.7 ml/m2 vs. 67.2 ± 20.9 ml/m2, P = 0.018], LA-EAT volume (34.8 ± 11.5 cm3 vs. 28.1 ± 10.6 cm3, P < 0.001) and LA-EAT attenuation (−93.9 ± 5.3 HU vs. −90.4 ± 5.5 HU, P < 0.001). Multivariate regression analysis showed that age (OR = 1.040; 95%CI: 1.001–1.078, P = 0.042), LAVI (OR = 1.019; 95%CI: 1.002–1.037, P = 0.032), LA-EAT volume (OR = 1.193; 95%CI: 1.015–1.402, P = 0.034) and attenuation value (OR = 0.801; 95%CI: 0.701–0.916 P = 0.001) were independent predictors of LVZ. After LA-EAT attenuation was incorporated into the clinical model, the comprehensive discrimination and net reclassification tended to improve (IDI and NRI > 0, P < 0.05).ConclusionLA-EAT volume and attenuation values can independently predict the presence of LVZ, and LA-EAT attenuation has a better predictive value than LA-EAT volume.

Left atrial epicardial adipose tissue is closely associated with left atrial appendage flow velocity in patients with nonvalvular atrial fibrillation

Epicardial adipose tissue (EAT) can play an important role in the occurrence and development of atrial fibrillation and stroke. In this study, we explored the relationship between left atrial epicardial adipose tissue (LA-EAT) and left atrial appendage flow velocity (LAA-FV) in patients with nonvalvular atrial fibrillation (NV-AF). A total of 145 patients with NV-AF who underwent their first radiofrequency ablation were enrolled. They underwent left aortopulmonary vein computed tomography angiography (CTA) and transesophageal echocardiography (TEE) before AF ablation. Left atrial (LA) electroanatomical mapping was performed intraoperatively to assess left atrial voltage. Univariate regression analysis showed that LAA-FV was lower in patients with a low voltage zone (LAA-FV; 35.02 ± 10.78 cm/s vs. 50.60 ± 12.17 cm/s, P < 0.001). A multiple linear regression model showed that the left atrial low voltage zone (β = − 0.311 P < 0.001), LA-EAT volume (β = − 0.256 P < 0.001), left atrial appendage shape (β = − 0.216 P = 0.041), LAVI (β = − 0.153 P = 0.041), and type of atrial fibrillation (paroxysmal vs. persistence) (β = − 0.146 P < 0.048) were independent predictors of LAA-FV. In NV-AF patients, the increase in LA-EAT volume is related to the decrease in LAA-FV.