Recurrence Of Atrial Fibrillation Patients Research Articles

Comparison of inflammatory markers for the prediction of atrial fibrillation recurrence following cryoablation.

Aim: The aim of this study is to investigate the value of inflammatory markers for atrial fibrillation (AF) recurrence prediction after cryo-balloon ablation (CA).Materials & methods: The study included 399 patients divided into twogroups by AF recurrence after CA. Inflammatory markers including uric acid/albumin ratio (UAR), systemic immune inflammation index (SIII) and CRP/albumin ratio (CAR) were evaluated.Results: UAR, SIII, and CAR were independently associated with the risk of recurrence in AF patients following CA. In ROC curve analysis, CAR had a greater area under curve (AUC:0.73) value than either SIII (AUC:0.68) or UAR (AUC:0.64).Conclusion: Our study results indicate that CAR compared with SIII and UAR had a greater predictive value than others inflammatory markers in predicting AF recurrence post-CA.

Quantitative and qualitative assessment of left atrial cardiomyopathy as well as prediction of atrial fibrillation recurrences upon PVI using machine learning

Abstract Introduction Atrial fibrillation (AF) is one of the most common heart pathologies in daily clinical practice and confers significant mortality and morbidity. However, AF ablation often proves ineffective - even after successful pulmonary vein isolation (PVI). The prediction of PVI failure for the long-term treatment of AF as well as the improved assessment of the underlying substrate appears pivotal. We hypothesize, that ML can be applied to better characterize the substrate and recurrence in AF patients upon PVI. Methods & Results We retrospectively evaluated data from 205 patients that underwent AF ablation between 2019 and 2023, including high-density 3D electroanatomic maps (sinus rhythm), LA rotational angiography, invasive LA hemodynamic measurements (after transseptal passage), echocardiography, 12-lead ECG and laboratory testing. A neuronal net was trained on selected features extracted from those datasets using supervised learning and employed to predict measures of atrial cardiomyopathy and AF recurrence. Patients were 66±1 years old and received first or second pulmonary vein isolation (PVI) for paroxysmal atrial fibrillation with 18% documented recurrences upon a mean follow-up of 23±1months. First, we extensively refined or developed tools for automated P-wave analysis from 12-lead ECGs as well as local LA voltage and volume quantification. Next, LA hemodynamics and volumes were assessed: Mean LA volume as derived from rotational angiography significantly correlated with LA volume index as obtained using echocardiography. Interestingly, LA size showed no correlation with NT-proBNP, LA low voltage or LA hemodynamics. In addition, global (25±2% of total LA area) and local (i.e. anterior, posterior, roof) LA voltage was determined and shown to be an independent predictor of AF recurrence. In our first unselected subset of 136 patients with 2nd PVI for atrial fibrillation, our ML models predicted LA fibrosis (i.e. low voltage regions; Utah stage) from 12-lead ECGs with an accuracy of 90%. Accuracy was 87% for the prediction of AF recurrences from LA pressure and low-voltage regions. In addition, the algorithm predicted AF recurrences from 12-lead SR ECGs obtained before PVI with an accuracy of 91%. Conclusion Artificial neural networks allow to quantitatively and qualitatively predict measures of atrial cardiomyopathy and atrial fibrillation recurrence probability upon complete PVI with high accuracy.Figures

Development and Validation of a Predictive Model Based on LASSO Regression: Predicting the Risk of Early Recurrence of Atrial Fibrillation after Radiofrequency Catheter Ablation.

Although recurrence rates after radiofrequency catheter ablation (RFCA) in patients with atrial fibrillation (AF) remain high, there are a limited number of novel, high-quality mathematical predictive models that can be used to assess early recurrence after RFCA in patients with AF. To identify the preoperative serum biomarkers and clinical characteristics associated with post-RFCA early recurrence of AF and develop a novel risk model based on least absolute shrinkage and selection operator (LASSO) regression to select important variables for predicting the risk of early recurrence of AF after RFCA. This study collected a dataset of 136 atrial fibrillation patients who underwent RFCA for the first time at Peking University Shenzhen Hospital from May 2016 to July 2022. The dataset included clinical characteristics, laboratory results, medication treatments, and other relevant parameters. LASSO regression was performed on 100 cycles of data. Variables present in at least one of the 100 cycles were selected to determine factors associated with the early recurrence of AF. Then, multivariable logistic regression analysis was applied to build a prediction model introducing the predictors selected from the LASSO regression analysis. A nomogram model for early post-RFCA recurrence in AF patients was developed based on visual analysis of the selected variables. Internal validation was conducted using the bootstrap method with 100 resamples. The model's discriminatory ability was determined by calculating the area under the curve (AUC), and calibration analysis and decision curve analysis (DCA) were performed on the model. In a 3-month follow-up of AF patients (n = 136) who underwent RFCA, there were 47 recurrences of and 89 non-recurrences of AF after RFCA. P, PLR, RDW, LDL, and CRI-II were associated with early recurrence of AF after RFCA in patients with AF (p < 0.05). We developed a predictive model using LASSO regression, incorporating four robust factors (PLR, RDW, LDL, CRI-II). The AUC of this prediction model was 0.7248 (95% CI 0.6342-0.8155), and the AUC of the internal validation using the bootstrap method was 0.8403 (95% CI 0.7684-0.9122). The model demonstrated a strong predictive capability, along with favorable calibration and clinical applicability. The Hosmer-Lemeshow test indicated that there was good consistency between the predicted and observed values. Additionally, DCA highlighted the model's advantages in terms of its clinical application. We have developed and validated a risk prediction model for the early recurrence of AF after RFCA, demonstrating strong clinical applicability and diagnostic performance. This model plays a crucial role in guiding physicians in preoperative assessment and clinical decision-making. This novel approach also provides physicians with personalized management recommendations.

Abstract 17865: Machine Learning With Multimodal Pre Ablation Imaging for Predicting Recurrence in Atrial Fibrillation Patients

Purpose: Catheter ablation is a popular treatment option for atrial fibrillation (AF), but AF recurrence is common. Currently, no marker exists to reliably predict the risk or location of recurrence (AF+). In this work, a multimodal imaging approach was employed to identify surface of interest (SOI) associated with recurrence using pre-ablation MRI and CT scans. Hypothesis: Shape of the left atrium (LA) plays a critical role in AF recurrence. The difference between AF+ and AF- may be identified on pre-ablation scan and may find potential sites for additional pre-emptive ablation. Method: Two representative template scans were selected from each group and all patients were registered to these respective templates to develop an atlas for each group. The two atlases were then co-registered, and the difference areas were obtained using a t-test with 500 permutations. The SOI was identified as the area that showed statistically significant (p &lt;0.05) differences between the AF+ and AF-. The process was repeated 5 times to obtain most frequent SOI. Since no ground truth for SOI exists, we used a multimodal imaging approach to construct atlases on CT and MRI; the corresponding SOIs were compared. Results: 102 CT (51 AF+) and 160 MRI (79 AF+) scans collected from Cleveland Clinic and Vanderbilt University were randomly sampled 5 times. At each iteration 20 patients from AF+ and AF- patients were randomly chosen and employed to create atlases for generating SOIs. The dice sore of MRI and CT derived SOI were 0.75± 0.08 and 0.82±0.05, respectively. The SOI region was below the LA appendage and left inferior pulmonary vein on both CT and MRI. The ratio of significant region to LA volume were [9%-18%] and [8%-19%] for CT and MRI, respectively indicating a good agreement between two SOIs. Conclusion: We identified SOI associated with AF+ from CT and MRI and found correlation between them at sites expected to be near the vein of Marshall, an area increasingly targeted for recurrent AF after prior ablation.

Atrial Fibrillation and Ischemic Stroke despite Oral Anticoagulation.

Patients with atrial fibrillation (AF) experiencing ischemic stroke despite oral anticoagulation (OAC), i.e., breakthrough strokes, are not uncommon, and represent an important clinical subgroup in view of the consistently high risk of stroke recurrence and mortality. The understanding of the heterogenous potential mechanism underlying OAC failure is essential in order to implement specific therapeutic measures aimed at reducing the risk of recurrent ischemic stroke. However, due to the incomplete comprehension of this phenomenon and the limited available data, secondary stroke prevention in such high-risk patients represents a clinical dilemma. There are several available strategies to prevent ischemic stroke recurrence in AF patients with breakthrough stroke in the absence of competing causes unrelated to AF, and these include continuation or change in the type of OAC, addition of antiplatelet therapy, left atrial appendage closure, or any combination of the above options. However, due to the limited available data, the latest guidelines do not provide any specific recommendations about which of the above strategies may be preferred. This review describes the incidence, the clinical impact and the potential mechanisms underlying OAC failure in AF patients. Furthermore, the evidence supporting each of the above therapeutic options for secondary stroke prevention and the potential future directions will be discussed.

PO-04-208 CLINICAL APPLICATION OF ARTIFICIAL INTELLIGENCE IN PREDICTION OF RECURRENCE IN ATRIAL FIBRILLATION PATIENTS WITH CATHETER ABLATION

The atrial fibrillation (AF) recurrence is still a challenging issue after catheter ablation. It is important to identify which patients are intended to have a post-ablation recurrence before ablation for decision-making. We aimed to build AI models in PVCT images and clinical variables. We also combined deep learning in PVCT images and machine learning of clinical parameters by nonparametric statistical method or I-score to build an ensemble model to predict the post-ablation one-year AF recurrence. We retrospectively analyzed 518 PAF patients who have undergone catheter ablation of PAF (Table 1). PVCT geometric slices (2-3mm for each slice, 20-200 slices for each patient, a total of 36943 images of slices in 518 AF patients) were used in the deep learning process for the prediction of AF trigger origin as model 1. In 1 year follow-up, there was no AF recurrence in 388 (74.9%) patients (Group 1) and AF recurrence in 130 (25.1%) patients (Group 2). The deep learning process (EfficientNet) of cardiac CT geometric slices was applied for the prediction of AF recurrence. A total of 43 clinical variables were obtained before catheter ablation, including baseline characteristics, personal habits, medical histories, a stroke risk score of AF, laboratory values of blood tests, transthoracic echocardiographic parameters, left atrial volume calculated by 3D geometric reconstruction, and medications. Using different machine learning methods, the predictive performance of clinical variables using all variables or selected features by Nonparametric Statistics ranged from an AUC of 0.691 to 0.760. the predictive performance of clinical variables by I-Score was between AUC of 0.702 to 0.729 (Table 2). The best predictive performance was an AUC of 0.729 using I-Score rank 3 parameters (Table 3) and the CatBoost machine learning method. We combined the features of PVCT images and clinical variables. The ensemble model was able to promote the predictive performance up to an AUC of 0.722 (accuracy of 75.9%, sensitivity of 50.0%, and specificity of 83.7%) in the test set. Deep-learning AI using pre-ablation cardiac CT and clinical variables can be applied in the prediction of recurrence in AF patients receiving catheter ablation. Application of this model may identify patients with post-ablation AF recurrence.

Circulating miR-451a Expression May Predict Recurrence in Atrial Fibrillation Patients after Catheter Pulmonary Vein Ablation.

Atrial fibrillation is the most prevalent tachyarrhythmia in clinical practice, with very high cardiovascular morbidity and mortality with a high-cost impact in health systems. Currently, it is one of the main causes of stroke and subsequent heart failure and sudden death. miRNAs mediate in several processes involved in cardiovascular disease, including fibrosis and electrical and structural remodeling. Several studies suggest a key role of miRNAs in the course and maintenance of atrial fibrillation. In our study, we aimed to identify the differential expression of circulating miRNAs and their predictive value as biomarkers of recurrence in atrial fibrillation patients undergoing catheter pulmonary vein ablation. To this effect, 42 atrial fibrillation patients were recruited for catheter ablation. We measured the expression of 84 miRNAs in non-recurrent and recurrent groups (45.2%), both in plasma from peripheral and left atrium blood. Expression analysis showed that miRNA-451a is downregulated in recurrent patients. Receiver operating characteristic curve analysis showed that miR-451a in left atrium plasma could predict atrial fibrillation recurrence after pulmonary vein isolation. In addition, atrial fibrillation recurrence is positively associated with the increment of scar percentage. Our data suggest that miRNA-451a expression plays an important role in AF recurrence by controlling fibrosis and progression.

A Prognostic Score To Predict Atrial fibrillation Recurrence After External Electrical Cardioversion-SLAC Score.

Atrial fibrillation (AF) recurrence after a successful external electrical cardioversion (ECV) is common. Assessing an individual's risk of AF recurrence is a critical part of the treatment plan. We aimed to develop a prognostic prediction score to predict AF recurrence in AF patients who underwent successful ECV. A retrospective cohort study that included AF patients who underwent successful ECV was conducted with a primary outcome of AF recurrence at 6 months. Logistic regression analysis was done to identify variables, and a prognostic prediction score was created and internally validated. Four prognostic predictors were identified, including the type of AF, persistent AF (1 point) and long-standing persistent AF (4 points), previous cardioversion (1 point), stroke/transient ischemic attack (3 points), and left atrial volume index ≥40 mL/m 2 (6 points). The total score of 14 was further divided into 3 risk groups; low-risk (0-2 points), moderate-risk (3-7 points), and high-risk (8-14 points). The positive likelihood ratio for a moderate-risk patient was 2.08 (95% CI, 1.64-2.63) and for a high-risk patient was 7.90 (95% CI, 2.48-25.17). The score showed good discrimination power with the c-statistic of 0.74 (95% CI, 0.69-0.79). A simple prognostic prediction score for AF recurrence after successful ECV was created with a promising internally validated discrimination power. An external assessment of its usefulness as a tool to identify patients with low, moderate, and high risk for AF recurrence is warranted.

Visit-to-Visit Blood Pressure Variability Predicts Atrial Fibrillation Recurrence After Pulmonary Vein Isolation in Patients With Hypertension and Atrial Fibrillation.

Background: The impact of preprocedural visit-to-visit blood pressure variability (BPV) on pulmonary vein isolation (PVI) outcome in patients with hypertension (HTN) and atrial fibrillation (AF) remains unclear.Methods and Results: This study enrolled 138 AF patients with HTN who underwent successful PVI. Patients were classified into 2 groups, those with AF recurrence (AF-Rec; n=42) and those without AF recurrence (No-AF-Rec; n=96). Blood pressure (BP) was measured at least 3 times during sinus rhythm, and systolic and diastolic BPV (Sys-BPV and Dia-BPV, respectively) were defined as the standard deviation of BP. Clinical characteristics were compared between the 2 groups, and the relationship between BPV and AF recurrence was investigated. Sys-BPV and Dia-BPV were significantly higher in the AF-Rec than No-AF-Rec group (Sys-BPV: 10.6±3.7 vs. 6.9±3.5; Dia-BPV: 7.3±3.1 vs. 4.8±3.0; P<0.05 for both). Receiver operating characteristic analysis revealed Sys-BPV 9.1 and Dia-BPV 5.7 as cut-off values for AF recurrence. Kaplan-Meyer analysis demonstrated higher AF recurrence in patients with Sys-BPV >9.1 and Dia-BPV >5.7 (P<0.05 for both). Cox multivariate regression analysis revealed that Sys-BPV >9.1 and Dia-BPV >5.7 were independent predictors of AF recurrence (hazard ratios 3.736 and 2.958, respectively; P<0.05 for both).Conclusions: Sys-BPV and Dia-BPV were associated with AF recurrence in AF patients with HTN.

Physical activity and atrial tachyarrhythmia recurrence in atrial fibrillation patients after catheter ablation.

The association between physical activity (PA) and atrial tachyarrhythmia (AT) recurrence after ablation for atrial fibrillation (AF) remains unclear. We consecutively enrolled 496 patients treated with AF ablation therapy in Beijing Anzhen Hospital. After excluding six patients with valvular heart disease, seven patients with congenital heart disease, 33 patients lost to follow-up, and 14 patients who did not provide PA level during follow-ups, 436 patients had their PA level assessed by the International Physical Activity Questionnaire-Short Form before ablation and each time of follow-up. The association between PA level (measured at the time closest to AT recurrence, or the end of 12-month follow-up if no AT recurrence), as well as active PA during follow-up, and postablation AT recurrence was tested by multivariate logistic regression. Of the enrolled patients, 134 (30.7%) patients experienced AT recurrence in the first 12 months postablation. Compared to patients with low PA, patients with moderate or high PA had a lower risk of AT recurrence (odds ratio [OR] = .44; 95% confidence interval [CI], .25-.80; P=.01 for patients with moderate PA; and OR = .43 [95% CI, .21-.85], P=.02 for patients with high PA). Compared to patients without active PA, patients with active PA had a lower risk of AT recurrence (OR = .44 [95% CI, .27-.70], P<.01). Moderate and high PA are associated with a lower risk of AT recurrence after AF ablation. Active PA during follow-up is also associated with a significantly lower risk of AT recurrence in the postablation AF population.

P1049Influence of body mass index on recurrence in atrial fibrillation patients after radiofrequency catheter ablation

Abstract Funding Acknowledgements No conflicts of interest INTRODUCTION Evidence has shown that obesity, expressed as high body mass index (BMI), is associated with the development of atrial fibrillation(AF). However, the relationship between BMI and recurrence of AF after catheter ablation(CA) remains controversial. Understanding this relationship, may help in regard to patient(p) counseling and management before and after CA. Purpose To evaluate single center AF recurrences after pulmonary vein isolation according to BMI status. Secondary endpoints were to compare the influence of other comorbilitys such as pulmonar disease or obstructive sleep apnea(OSA) METHODS We included 114p with AF(54,5 ± 9,6 years; male 75,4%; paroxysmal 70,2%; persistent 29,8%) treated with first time radiofrequency ablation between 2013 and 2018. On the basis of the baseline BMI, patients were categorized into 2 groups: normal/overweigth (BMI &amp;lt; 30kg/m2) and obese(BMI≥30kg/m2). RESULTS There was no significant difference between the majority of baseline characteristics of the groups (table 1), however patients with BMI≥30 were more likely to sufferd OSA(34% vs 8,2%:p = 0,001), to have larger left atrial (diameter &amp;gt; 40mm: 70,5% vs 46,3%;p = 0,004), and persistent AF (43,4% vs 18%; p 0,004). During 12 months of follow-up AF recurred in 34p (29,8%), the freedom from AF was significantly higher in the BMI &amp;lt; 30 group (48p(80%) vs 31(58,5%), p = 0,015). Multivariate analysis including variables of type of AF, OSA, BMI, left atrial size, ejection fraction, and hypertension demonstrated that BMI was the strongest predictor of being freedom from recurrent AF (OR = 0.35, 95% CI: 0,11–0,81, P = 0.014). A serious complication occurred in 6p(5,3%), with no relationship to BMI. CONCLUSION This study suggest that tight association between obesity and AF recurrence after ablation may be partly due to other concomitant conditions which in turn are more frequent in obese patients like OSA, left atrial size and presence of persistent AF. Abstract Table 1

The efficacy of combination of transcatheter atrial septal defects closure and radiofrequency catheter ablation for the prevention of atrial fibrillation recurrence through bi-atrial reverse remodeling.

Atrial fibrillation (AF) often coexists with atrial septal defects (ASD). Each of the transcatheter closure for ASD and radiofrequency catheter ablation (RFCA) for AF have been established as the first-line therapy. However, there are limited data about therapeutic effect RFCA plus transcatheter ASD closure on AF recurrence in AF patients with ASD. The aim of the current study was to investigate the clinical impact of ASD closure following RFCA on AF recurrence. Forty-two ASD patients (17 males and 54 ± 20 years old) were enrolled and classified into three groups: ASD occlusion-sinus rhythm (ASO-SR) (n = 26), no AF history prior to ASD closure; ASO-AF-RFCA (n = 11), RFCA was performed due to AF history before ASD closure; and ASO-AF-anti-arrhythmic drug (ASO-AF-AAD) (n = 5), AF was treated with AAD before and after ASD closure. AF occurrence among the 3 groups was evaluated. Kaplan-Meier analysis showed that ASO-SR and ASO-AF-RFCA groups showed a lower AF occurrence ratio than ASO-AF-AAD group during the 14- ± 9-month follow-up periods (P = 0.013). AF occurrence in ASO-SR and ASO-AF-RFCA groups was comparable (P = 0.480). Bi-atrial reverse remodeling, such as decrease in left atrial volume index (P = 0.049) and right atrial area (P = 0.046), and significant decrease in high-sensitivity C-reactive protein levels (P = 0.049) were identified in ASO-AF-RFCA group, but not in ASO-AF-AAD group. A combination of two percutaneous therapies was proven to be effective and induced bi-atrial reverse remodeling in association with inflammatory reaction.

GW29-e1645 Effect of Continuous Positive Airway Pressure on the Recurrence of Atrial Fibrillation Patients: a Meta-Analysis

GW29-e1645 Effect of Continuous Positive Airway Pressure on the Recurrence of Atrial Fibrillation Patients: a Meta-Analysis

GW29-e1621 Predictive value of plasma miRNA-21 on recurrence of atrial fibrillation patients after radiofrequency catheter ablation

GW29-e1621 Predictive value of plasma miRNA-21 on recurrence of atrial fibrillation patients after radiofrequency catheter ablation

Research of Dual-pulse wave Doppler for left ventricular diastolic function in atrial fibrillation and predicting recurrence after radiofrequency catheter ablation

Objective To explore the value of parameters obtained by dual-pulse wave Doppler to predict the recurrence of atrial fibrillation (AF) after radiofrequency catheter ablation(RFCA) and the value of the technology to evaluate the left ventricular diastolic function of the AF. Methods Sixty-seven AF patients who were subjected to ablation were selected as the case group, and 47 patients with sinus rhythm were matched as control group. The general clinical data of the case group and the control group was collected, routine ultrasound examination and dual-pulse wave Doppler examination were performed to all of them. A 24-hour Holter examination was performed at 3, 6 and 12 months after radiofrequency catheter ablation in the case group, the patients were divided into two groups with and without recurrence according to the results. Dual-pulse wave Doppler parameters included: ①the time interval between the onset of early transmitral flow velocity (E) and that of early diastolic mitral annular velocity (e′) (TE-e′); ②peak early diastolic transmitral flow velocity (E) and tissue Doppler septal (S) mitral annular early diastolic velocity (e′), peak early diastolic transmitral flow velocity (E) and tissue Doppler lateral (L) mitral annular early diastolic velocity (e′), E/e′(S) and E/e′(L). The differences between the case group and the control group, and between the recurrent and the non-recurrent group were compared. The factors influencing the recurrence of AF after RFCA were analyzed with univariate and multivariate Logistic regression. Results ①The parameters E/e′(S), E/e′(L) and TE-e′ of case group were higher than those of control group (all P 0.05); ③Univariate and multivariate Logistic regression suggested that TE-e′ was an independent predictor for the recurrence of AF patients after the ablation(P=0.001). Conclusions Dual-pulse wave Doppler can evaluate left ventricular diastolic function of atrial fibrillation, TE-e′ is an independent predictor for the recurrence of AF patients after radiofrequency catheter ablation. Key words: Echocardiography; Atrial fibrillation; Radiofrequency catheter ablation; Dual-pulse wave Doppler; Recurrence

Predictive value of epicardial adipose tissue thickness for the recurrence of atrial fibrillation after concomitant valve replacement and bipolar radiofrequency ablation

Objective To investigate the predictive value of epicardial adipose tissue(EAT) thickness for the recurrence of atrial fibrillation(RAF) after concomitant valve replacement and bipolar radiofrequency ablation. Methods From January 2012 to May 2014, 156 patients with permanent atrial fibrillation and organic valvular diseases underwent concomitant valve replacement and successful bipolar radiofrequency ablation in the First People's Hospital of Shangqiu.After 1 year of follow-up, the recurrence of AF was analyzed and the correlation factors were analyzed statistically. Results All patients completed a regular follow-up.During a 12-month follow-up period, RAF was observed in 39 patients(25.0%). Echocardiography-derived regional EAT thickness was significantly greater in RAF patients than that in non-RAF patients((6.9±0.6) mm vs.(5.5±0.7) mm, t=4.649, P<0.05). The EAT thickness strongly correlated with patients age, body mass index, Ratio of left atrial diameter, mitral diastolic blood flow velocity and early diastolic velocity of mitral annulus, low density lipoprotein-cholesterol and thyroglobulin(r=0.62, 0.57, 0.68, 0.59, 0.73, 0.76; P<0.05). Cox multivariable analysis showed that, duration of AF history(95%CI: 1.01-1.15, P=0.040), left atrial diameter(95%CI: 1.07-1.24, P=0.021) and EAT thickness(95%CI: 1.05-1.79, P=0.009) were independent predictors of RAF. Conclusion Echocardiography-derived regional EAT thickness combined with left atrial diameter may serve as effective parameters in identifying patients at the highest risk for RAF. Key words: Valvular heart disease; Atrial fibrillation; Epicardial adipose tissue; Catheter ablation

Abstract 12012: Relation Between Colchicine and Epicardial Adipose Tissue Volume Surrounding Left Atrium in Atrial Fibrillation Recurrence After Ablation

Background: Immediate recurrence of atrial fibrillation (AF) after AF ablation was related with inflammatory process. Colchicine treatment after AF ablation can reduce AF recurrence by suppression of such inflammatory reactions. The epicardial adipose tissue (EAT) has been shown to release activated pro-inflammatory cytokines and to associate with the development of AF. However, it is unclear whether colchicine treatment affects recurrence of AF according to EAT volume of left atrium (LA-EAT volume). The purpose of this study was to evaluate the relation between reduction of AF recurrence by colchicine treatment after AF ablation and LA-EAT volume. Methods: One hundred twenty two consecutive AF patients who underwent AF ablation and in whom multi-detector computed tomography was performed before ablation were included. Colchicine was prescribed to patients who approved colchicine treatment and was started at 0.5 mg/day for 2 weeks after AF ablation. We divided the study patients into larger LA-EAT group and smaller LA-EAT group according to the median (22.4 cm3) of LA-EAT volume. LA-EAT volume was obtained by semi-automatically tracing axial images from the bifurcation of the pulmonary artery to the coronary sinus and EAT was recognized using threshold attenuation values of -50 to -200 HU. In each group, we compared incidences of AF recurrence (AF &gt; 30 sec) in 3 months and 12 months after ablation between colchicine group and non-colchicine group. Results: Forty-two patients received colchicine. In larger LA-EAT group (&gt; 22.4 cm3) (n=60) incidence of AF recurrence in colchicine group showed lower tendency in 12 months after ablation (10.5% vs. 34.2%, p=0.06) while in smaller LA-EAT group (&lt; 22.4 cm3) (n=62), incidence of AF recurrence was similar between colchicine group and non-colchicine group (Table). Conclusion: Colchicine treatment after AF ablation may reduce mid-term AF recurrence in AF patients with larger LA-EAT volume.