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

Termination of persistent atrial fibrillation (PersAF) during radiofrequency catheter ablation (RFCA) is closely related to the outcome of the ablation. Epicardial adipose tissue (EAT) plays an important role in the maintenance of AF. The role of EAT on the termination of PersAF has not been reported. The aim of this study was to evaluate the association between left atrial EAT (LA-EAT) and termination of PersAF during pulmonary vein isolation (PVI).

This was a single-center retrospective observational study. Consecutive enrolment of PersAF who underwent first-time radiofrequency ablation between January 2021 and August 2022. All patients underwent computed tomography angiography (CTA) examination of the left atrium, and the LA-EAT was measured using medical software (Advantage Workstation 4.6, GE, USA). Termination of PersAF during ablation was defined as conversion of AF to sinus rhythm (SR) or stable atrial flutter (AFL)/atrial tachycardia (AT).

A total of 203 PersAF patients were enrolled, atrial fibrillation rhythm termination during PVI in 42 patients. Multivariate analysis showed that duration of AF, Heart failure (HF), and LA-EAT volume (OR = 0.960; 95%CI: 0.926- 0.996, p = 0.029) were independent predictors of termination. ROC analysis showed that the model including AF duration, HF, and LA-EAT had an effective ability to predict the termination (AUC = 0.734, 95% CI:0.647-0.802, p < 0.001). When LA-EAT was integrated into the model of characteristics routinely (including AF duration and HF), the discrimination and reclassification accuracy for the termination were significantly improved (NRI 0.2143, 95% CI 0.0724-0.3562, p = 0.003; IDI 0.0291, 95% CI 0.0047-0.0535, p = 0.019). The analysis revealed a statistically significant difference in overall arrhythmia recurrence between the termination group and non-termination group (log-rank p = 0.038).

LA-EAT is independently associated with the termination of PersAF during PVI CLINICAL TRIAL NUMBER: Not applicable.