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Published on: April 11, 2025
Epicardial adipose tissue in paroxysmal and persistent atrial fibrillation ablation using photon counting CT and
Nico Erhard1, Fabian Bahlke1, Simon Prommersberger1
1Department of Electrophysiology, German Heart Centre Munich, TUM University Hospital, Technical University of Munich, Munich, Germany.
Background:
Epicardial adipose tissue (EAT) may contribute to atrial fibrillation (AF) pathogenesis and recurrence after catheter ablation, but data using precise volumetric quantification alongside systematic body composition assessment are limited.
Objective:
To quantify biatrial EAT using photon-counting CT (PCCT) with semiautomated 3D segmentation and assess its association with arrhythmia recurrence after first-time catheter ablation in paroxysmal and persistent AF.
Methods:
In this prospective observational study, 210 adults undergoing first-time catheter ablation at the German Heart Centre Munich underwent preprocedural PCCT with 3D biatrial EAT reconstruction and protocolized whole-body composition assessment. The primary endpoint was freedom from any atrial arrhythmia at one year following an 8-week blanking period, assessed by 7-day Holter monitoring at 3, 6 and 12 months.
Results:
Median age was 68.0 years and median body mass index 27.0 kg/m2 (IQR 24.5-30.0). Median left atrial (LA) EAT volume was 30.4 mL (IQR 23.5-40.1) and right atrial EAT 31.2 mL (IQR 23.8-38.0); the two were strongly correlated (r = 0.92, P < 0.0001). Patients with persistent AF had higher LA and right atrial EAT than those with paroxysmal AF (32.1 vs 28.0 mL and 33.4 vs 27.7 mL; P < 0.01). One-year arrhythmia freedom was 81.9% in paroxysmal and 57.3% in persistent AF (P = 0.005). In multivariable Cox regression, greater LA EAT per 10-mL increase was associated with recurrence in persistent AF (HR 1.51, 95% CI 1.06-2.15) but not paroxysmal AF (HR 0.79, 95% CI 0.54-1.15; P for interaction = 0.014). LA EAT was not associated with low-voltage substrate.
Conclusion:
PCCT enables precise biatrial EAT quantification. LA EAT was associated with arrhythmia recurrence in persistent but not paroxysmal AF, supporting its potential as an imaging biomarker.
