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Updated: Apr 30, 2026
Real-Time Cardiac Mapping with a Noninvasive Imageless Electrocardiographic Imaging System
Published on: April 11, 2025
Epicardial adipose tissue-based defragmentation approach to persistent atrial fibrillation: its impact on complex
Shiro Nakahara1, Yuichi Hori1, Sayuki Kobayashi1
1Department of Cardiology, Dokkyo Medical University Koshigaya Hospital, Saitama, Japan.
Background:
Increased epicardial adipose tissue (EAT) volume is associated with atrial fibrillation (AF). However, the efficacy of EAT-based left atrial (LA) ablation for persistent AF (PsAF) is unclear.
Objective:
The purpose of this study was to assess whether EAT-based LA ablation is effective for PsAF.
Methods:
In 60 PsAF patients (group I), 3-dimensional reconstructed computed tomography images depicting EAT were merged with NavX-based dominant-frequency (DF) and complex fractionated electrogram (CFE) maps obtained during AF. Pulmonary vein antrum isolation (PVAI) was followed by map-guided EAT-based ablation. Results were compared to those in a historical control group (group II, case-matched patients who underwent generalized stepwise ablation including linear plus CFE-targeted ablation).
Results:
In 70% (n = 42) of group I patients, the LA-EAT was located at the pulmonary vein antra; anterior and inferior surfaces, roof, septum, and mitral annulus; and left atrial appendage. EAT was at or near (<3 mm) 71% (390/550) of high-DF (> -8 Hz) sites. In 41 patients with persistent AF despite EAT-targeted ablation, CFE burden decreased significantly (from 96% to 13%, P < .0001), and DF decreased within the coronary sinus (6.9 ± 0.7 Hz vs 5.9 ± 0.7 Hz, P < .0001). Radiofrequency energy duration was significantly less in group I than in group II (25 ± 6 minutes vs 31 ± 12 minutes, P < .05). During 16-month follow-up, freedom from AF on antiarrhythmic drugs was 78% vs 60% (P < .05).
Conclusion:
PVAI plus EAT-based ablation efficiently eliminates high-frequency sources and yields relatively high success. EAT-based LA ablation is a simple, clinically feasible PsAF ablation strategy.
