Left Atrial Epicardial Adipose Tissue Associated With Persistent AF Termination During Pulmonary Vein Isolation

Area of Science:

• Cardiology
• Medical Imaging
• Electrophysiology

Background:

• Persistent atrial fibrillation (PersAF) management relies on successful radiofrequency catheter ablation (RFCA).
• Epicardial adipose tissue (EAT) influences atrial fibrillation (AF) maintenance.
• The impact of EAT on PersAF termination during RFCA remains uninvestigated.

Purpose of the Study:

• To investigate the association between left atrial EAT (LA-EAT) and the termination of PersAF during pulmonary vein isolation (PVI).

Main Methods:

• Retrospective observational study of 203 PersAF patients undergoing first-time RFCA.
• Left atrial EAT volume measured via computed tomography angiography (CTA).
• Termination defined as conversion to sinus rhythm or stable atrial flutter/tachycardia during PVI.

Main Results:

• LA-EAT volume, AF duration, and heart failure were independent predictors of PersAF termination.
• A model incorporating LA-EAT demonstrated improved prediction accuracy for termination.
• Integration of LA-EAT significantly enhanced discrimination and reclassification of termination prediction.

Conclusions:

• Left atrial EAT is an independent predictor of PersAF termination during PVI.
• LA-EAT volume is a significant factor in achieving successful ablation outcomes.
• Further research into EAT's role in AF ablation is warranted.