Fat content surrounding your heart may cause your arrhythmia to recur

Epicardial adipose tissue (EAT) is a metabolically active fat depot surrounding the heart. It is located between the outer wall of myocardium and the visceral pericardium. Its proximity to cardiac structures (i.e. vessels, myocardium) and its shared blood supply with the cardiac microcirculation makes it a unique fat depot. In our study, we investigated whether there is an association between thickness of this fat tissue and success of cryoballoon- based pulmonary vein isolation (PVI), which is an accepted therapeutic alternative for eliminating foci of arrhythmogenesis.

Fig. 1. Figure comparing periatrial EAT thickness between patients with (a) and without (b) AF recurrence.

Fig. 1. Figure comparing periatrial EAT thickness between patients with (a) and without (b) AF recurrence.

For this purpose, we recruited 249 patients who were scheduled for cryoballoon- based PVI for AF per the recent recommendations and followed them up for a median of 29 months. We recorded EAT thickness of all patients during multidetector computed tomography (MDCT) scans, which were obtained prior to the procedure. During follow- up, 75.9% of the study population were found to remain AF- free. Total EAT thickness adjacent to the atria (periatrial EAT) was greater in patients with AF recurrence when compared to those without (18.1± 6.2 vs. 14.7± 4.7 mm, p<0.001) (Figure). When other factors that are associated with AF recurrence (i.e. persistency and duration of AF; atrial and ventricular dimensions) were taken into account, periatrial EAT thickness (HR: 1.086, p=0.001) and left atrial volume index (HR: 1.144, p<0.001) were shown to be independent predictors for AF recurrence. In other words, our findings showed that each 1 mm increase in periatrial EAT resulted in 8% increase in AF recurrence risk. The link between EAT and AF recurrence may be explained with the role of EAT in promoting inflammation, by serving as a paracrine source of inflammatory mediators; including IL-1, IL-6, TNF-α, MCP-1, nerve growth factor (NGF), resistin, plasminogen activator inhibitor-1 (PAI-1), and free fatty acids, that possibly lead to AF initiation and maintenance. Therefore, quantification of EAT thickness from pre- procedural MDCT scans may serve as a beneficial parameter for prediction of AF recurrence following cryoballoon- based PVI procedure. Further studies are needed to establish its exact pathophysiologic and prognostic role.



Periatrial epicardial adipose tissue thickness is an independent predictor of atrial fibrillation recurrence after cryoballoon-based pulmonary vein isolation.
Kocyigit D, Gurses KM2, Yalcin MU, Turk G, Evranos B, Yorgun H, Sahiner ML, Kaya EB, Hazirolan T, Tokgozoglu L, Oto MA, Ozer N, Aytemir K
J Cardiovasc Comput Tomogr. 2015 Jul-Aug


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