Background
Epicardial adipose tissue (EAT) around the left atrium (LA) can change the electric
conduction of the LA, potentially leading to atrial fibrillation (AF).
Aim
The aim of this study was to evaluate whether an association existed between EAT and
the electrophysiological properties of adjacent atrial myocardium in patients with
AF.
Method
A total of 201 consecutive patients referred for initial AF catheter ablation were
prospectively included. A preprocedural computed tomography scan was performed to
assess total and LA-EAT parameters. Detailed point-by-point voltage mapping using
an electroanatomical mapping system was realised to assess the LA low-voltage zone
(LVZ), defined as an area with bipolar electrograms ≤0.5 mV during sinus rhythm.
Results
Ninety-one (91) patients (45.3%) presented at least one LVZ. They had a significantly
more severe AF pattern (p=0.04) than patients without LVZ, and little difference existed
with regard to other clinical variables. Patients with LVZ presented significantly
more total EAT volume (162.4±71.3 mL vs 135.5±57.2 mL; p=0.03) and LA-EAT volume (26.4±15.9
mL vs 20.9±10.5 mL; p<0.01) than no-LVZ patients. Multivariable logistic regression
analyses revealed total EAT volume index to be an independent predictor of the presence
of LVZ (odds ratio [OR] 1.01; 95% confidence interval [CI] 1.01–1.04; p<0.01) and
LA-EAT percentage to be an independent predictor of severe LVZ (OR 1.34; 95% CI 1.18–1.64;
p<0.001).
Conclusions
The EAT volume and its distribution around the LA may indicate the presence and severity
of LVZ. The assessment of the volume of EAT and its distribution may lead to better
risk stratification in patients with AF.
Keywords
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Article info
Publication history
Published online: August 10, 2022
Accepted:
July 7,
2022
Received in revised form:
June 4,
2022
Received:
March 18,
2022
Identification
Copyright
© 2022 Published by Elsevier B.V. on behalf of Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ).
ScienceDirect
Access this article on ScienceDirectLinked Article
- What is the Relationship Between Epicardial Adipose Tissue, Left Atrial Low Voltage Zones and Atrial Fibrillation?Heart, Lung and CirculationVol. 31Issue 11
- PreviewThe pathophysiology of atrial fibrillation (AF) is complex and remains incompletely understood. Structural and electrophysiological remodelling of the left atrium have shown to create substrates leading to the development of AF, with atrial fibrotic changes demonstrated to be both present [1] and pathological [2]. Catheter ablation, primarily as pulmonary vein isolation (PVI), has become the core part of the ablation therapy for AF. However, persistent pulmonary vein electrical isolation remains difficult to achieve, and early recurrence of AF post ablation remains a major limiting factor [3].
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