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Atrial Fibrillation and Epicardial Adipose Tissue: A Bidirectional Relationship
Francis J Ha1, Andrew Lin1, Nitesh Nerlekar2
1Victorian Heart Hospital, Clayton, Victoria, Australia; Victorian Heart Institute, Monash University, Clayton, Victoria, Australia.
Heart Rhythm
|August 11, 2026
Summary
Epicardial adipose tissue (EAT) predicts atrial fibrillation (AF). Restoring sinus rhythm after AF ablation significantly reduces EAT volume, suggesting AF influences EAT. Further research is needed to clarify this bidirectional relationship.
Area of Science:
- Cardiology
- Biomedical Imaging
- Metabolic Research
Background:
- Epicardial adipose tissue (EAT) is a key predictor of atrial fibrillation (AF).
- EAT exhibits dynamic phenotypes, influencing myocardial electromechanical function.
- Emerging evidence suggests a bidirectional relationship between AF and EAT.
Purpose of the Study:
- To investigate the impact of AF catheter ablation on EAT volume.
- To explore the mechanisms underlying changes in EAT post-ablation.
- To identify unresolved questions regarding the AF-EAT interaction.
Main Methods:
- Observational studies evaluating EAT volume before and after AF catheter ablation.
- Analysis of EAT volume changes independent of body mass index.
- Consideration of potential mechanisms including sinus rhythm restoration and ablation effects.
Main Results:
- Catheter ablation for AF leads to significant reductions in total and left atrial EAT volume.
- These reductions are observed independently of changes in body mass index.
- Sinus rhythm restoration is the most plausible mechanism driving EAT changes.
Conclusions:
- AF catheter ablation can reverse atrial myopathy by modulating EAT.
- Further research is required to disentangle weight loss effects and evaluate new ablation technologies like pulsed field ablation.
- Standardized imaging definitions for EAT analysis are crucial for advancing understanding.
