Clinical Electrophysiology -> Atrial Fibrillation & Atrial Flutter: -> Physiology D-MP09 - Atrial Fibrillation: From Pathophysiology to Epidemiology to Treatment Options (ID 36) Moderated ePoster

D-MP09-04 - Epicardial Adipose Tissue And Atrial Fibrillation: Guilty As Charged Or Guilty By Association? (ID 846)


Background: Epicardial adipose tissue (EAT) has been linked to the presence and burden of atrial fibrillation (AF). However, it is still unclear whether this relationship is causal or simply a surrogate marker of other risk factors commonly associated with AF.
Objective: The purpose of this study was to assess the relationship between these factors and EAT, and to compare their performance in predicting AF recurrence after an ablation procedure.
Methods: We assessed 575 consecutive patients (mean age 61±11 years, 62% male) undergoing AF ablation preceded by cardiac CT in a high-volume ablation center. EAT was measured on cardiac CT using a modified simplified method. Patients were divided into 2 groups (above vs. below the median EAT volume). Cox regression was used to assess the relationship between epicardial fat, risk factors, and AF relapse.
Results: Patients with above-median EAT volume were older (p<0.001), more often male (OR 1.7, p=0.002), had higher body mass index, and higher prevalence of smoking, hypertension, diabetes, and dyslipidemia (p<0.05). Non-paroxysmal AF was also more common in those with above-median EAT volume. During a median follow-up of 18 months, 232 patients (40.3%) suffered AF recurrence. After adjustment for BMI and other univariate predictors of relapse, three variables emerged independently associated with time to AF recurrence: non-paroxysmal AF (HR 2.03, 95%CI: 1.53-2.69, p<0.001), indexed left atrial (LA) volume (HR 1.02 per mL/m2, 95%CI: 1.01-1.02, p<0.001), and indexed epicardial fat volume (HR 1.55 per mL/m2, 95%CI: 1.43-1.67, p<0.001). None of the classic cardiovascular risk factors were an independent predictor of AF recurrence (all p>0.10).
Conclusion: Classic cardiovascular risk factors are more prevalent in patients with higher amounts of epicardial fat. However, unlike these risk factors, EAT is a powerful predictor of AF recurrence after ablation. These findings suggest that EAT is not merely a surrogate marker, but an important participant in the pathophysiology of AF.