ASSA13-02-23 Relationship of Thickness of Left Atrial Epicardial Adipose Tissue and Atrial Fibrillation

Abstract OBJECTIVES Epicardial adipose tissue volume (EAT-V) has been linked to atrial fibrillation (AF) recurrences after catheter ablation. We retrospectively studied the association between atrial EAT-V and outcome after hybrid AF ablation (epicardial surgical and endocardial catheter ablation). METHODS On preoperative cardiac computed tomography angiography scans, the left atrium and right atrium were manually delineated using the open source ImageJ. With custom-made automated software, the number of pixels in the regions of interest on each slice was calculated. On the basis of the Hounsfield units, pixel size and slice thickness, EAT-V was computed and normalized in relation to the body surface area (BSA) and the myocardial tissue volume. RESULTS Eighty-five patients were included. Left atrial and right atrial EAT-V normalized to BSA were not significantly different between paroxysmal and persistent AF [0.84 (0.51–1.50) vs 0.81 (0.57–1.18), 1.74 (1.02–2.56) vs 1.55 (1.26–2.18), all P = 0.9], neither between the acute conduction block and no acute conduction block in the epicardial box lesion [0.92 (0.55–1.39) vs 0.72 (0.55–1.24), P = 0.5, right atrium not applicable], nor between the sinus rhythm and arrhythmia recurrence after 12 months [0.88 (0.55–1.48) vs 0.63 (0.47–1.10), 1.61 (1.11–2.50) vs 1.55 (1.20–2.20), all P > 0.1]. Left atrial EAT-V normalized to myocardial tissue volume was not different between the groups. CONCLUSIONS This study could neither confirm that EAT-V was predictive of recurrence of supraventricular arrhythmias in patients undergoing a hybrid AF ablation, nor that EAT-V was different between patients with paroxysmal AF and persistent and long-standing persistent AF. This suggests that EAT-V might not affect the outcome in surgical ablation procedures and therefore should not influence preoperative or intraoperative decision-making.

Download Full-text

Does the volume of atrial epicardial adipose tissue predict the likelihood of postoperative atrial fibrillation?

EP Europace ◽

10.1093/europace/euab116.130 ◽

2021 ◽

Vol 23 (Supplement_3) ◽

Author(s):

CAJ Van Der Heijden ◽

JR Olsthoorn ◽

C Mihl ◽

S Heuts ◽

E Bidar ◽

...

Keyword(s):

Atrial Fibrillation ◽

Adipose Tissue ◽

Cardiac Surgery ◽

Left Atrial ◽

Structural Changes ◽

Epicardial Adipose Tissue ◽

Left Atrial Volume ◽

Outcome Data ◽

Funding Sources ◽

Custom Made

Abstract Funding Acknowledgements Type of funding sources: None. Background Atrial Epicardial Adipose Tissue (EAT) is involved in the early pathophysiological process of atrial fibrillation (AF). Its role in the occurrence of post-operative AF (POAF) is less well investigated. The transient occurrence of POAF suggests that surgery-induced triggers unmask a pre-existing AF substrate. Purpose As EAT induces structural changes in the atria, it is interesting to evaluate whether EAT also contributes to the substrate underlying the occurrence of early POAF (<30 days). We hypothesized that patients with high EAT volumes are more likely to develop POAF after cardiac surgery than patients with low EAT volumes. Methods Retrospective quantification of left atrial (LA) EAT was performed on pre-operative coronary computed tomography (CT) angiography scans of patients who underwent cardiac surgery between 2009 and 2017. Patients with a history of AF or with mitral valve disease were excluded, as well as thoracic CT scans. Analysis was based on the Hounsfield Units using custom made software. Results Of the 52 included patients 28 developed POAF. Neither the percentage of EAT in the left atrial (LA) wall nor normalized EAT volumes differed between the POAF and sinus rhythm group (all P > 0.05). After multivariate analysis, age was the only independent predictor for early POAF (OR:1.087 [1.000–1.181]). Conclusion A role for EAT in the occurrence of early POAF was not demonstrated. This might suggest that acute, surgical factors are more important in the onset of early POAF than chronic processes associated with EAT. More and larger trials are needed to confirm these results. EAT-V in the LA wallPOAF (n = 28)SR (n = 24)P-valueEAT-V (ml)0.77 (0.41 - 1.26)0.62 (0.36 - 1.13)0.425MYO-V (ml)3.24 (2.57 - 4.80)2.89 (2.14 - 3.76)0.121% EAT LA wall17.39 ± 8.2418.33 ± 8.400.687EAT-V (ml) / BSA (m²)0.42 (0.19 - 0.60)0.32 (0.22 - 0.73)1.000EAT-V (ml) / BMI (kg/m²) (%)2.67 (1.13 - 4.43)2.48 (1.66 - 4.56)0.927EAT-V (ml) / LAVI (ml/m²) (%)1.92 (1.00 - 4.43)1.51 (1.12 - 2.41)0.583EAT-V (ml) / MYO-V (ml) (%)21.63 (9.54 - 30.18)23.85 (16.75 - 32.79)0.244The percentage of EAT in the LA wall, EAT-V and indexed EAT-V to BSA, BMI, LAVI and MYO-V, based on post-operative rhythm outcome. Data are presented as median (interquartile range) or mean ± standard deviation. EAT-V: epicardial adipose tissue volume; MYO-V; myocardial volume; LA: left atrial; BSA: body surface area; BMI: body mass index; LAVI: left atrial volume index.Abstract Figure. EAT and MYO measurements

Download Full-text

B-PO04-087 EFFECT OF OBESITY ON LEFT ATRIAL WALL SUBSTRATE IN PATIENTS WITH ATRIAL FIBRILLATION: INSIGHT INTO EPICARDIAL ADIPOSE TISSUE AND FATTY INFILTRATION

Heart Rhythm ◽

10.1016/j.hrthm.2021.06.782 ◽

2021 ◽

Vol 18 (8) ◽

pp. S314

Author(s):

Ryuta Watanabe ◽

Koichi Nagashima ◽

Yuji Wakamatsu ◽

Naoto Otsuka ◽

Shu Hirata ◽

...

Keyword(s):

Atrial Fibrillation ◽

Adipose Tissue ◽

Left Atrial ◽

Epicardial Adipose Tissue ◽

Fatty Infiltration ◽

Atrial Wall ◽

Left Atrial Wall ◽

Insight Into

Download Full-text

Association of Epicardial Adipose Tissue Thickness with Left Atrial Size and Atrial Fibrillation

Cardiology and Angiology An International Journal ◽

10.9734/ca/2021/v10i430180 ◽

2021 ◽

pp. 60-66

Author(s):

Ahmed M. Abd ElSalam ◽

Amany M. Allaithy ◽

Mona Elsaedy ◽

Ekram Sadek Said

Keyword(s):

Atrial Fibrillation ◽

Adipose Tissue ◽

Left Atrial ◽

Epicardial Adipose Tissue ◽

Left Atrial Size ◽

Operating Characteristics ◽

Tissue Thickness ◽

Epicardial Adipose Tissue Thickness ◽

Atrial Size ◽

Significant Difference

Background: Atrial fibrillation (AF) is the most common cardiac arrhythmia and is associated with detrimental consequences. Epicardial fat is consistently associated with the presence, severity, and recurrence of AF. Aim: The aim of the work was to investigate the association of epicardial adipose tissue thickness with left atrial size in patients with atrial fibrillation. Patients and Methods: This study was conducted on 25 atrial fibrillation (AF) patients and 25 subjects with normal sinus rhythm as a control group matched in body weight. All patients underwent transthoracic echocardiogram. EAT (epicardial adipose tissue) thickness was measured on the right ventricular free wall of the two- dimensional parasternal long-axis view at end systole. Results: The results showed that there was a significant difference between the two groups in waist circumference, EAT (epicardial adipose tissue) thickness, left atrium diameter, LA volume. Receiver operating characteristics (ROC) analysis showed that an EAT thickness of > 0.30 cm maximizes the sensitivity and specificity to predict the development of AF. Conclusion: Increases epicardial adipose tissue is associated with the occurrence of atrial fibrillation.

Download Full-text

Association of left atrial epicardial adipose tissue with electrogram bipolar voltage and fractionation: Electrophysiologic substrates for atrial fibrillation

Heart Rhythm ◽

10.1016/j.hrthm.2016.08.030 ◽

2016 ◽

Vol 13 (12) ◽

pp. 2333-2339 ◽

Cited By ~ 26

Author(s):

Tarek Zghaib ◽

Esra Gucuk Ipek ◽

Sohail Zahid ◽

Muhammad Adnan Balouch ◽

Satish Misra ◽

...

Keyword(s):

Atrial Fibrillation ◽

Adipose Tissue ◽

Left Atrial ◽

Epicardial Adipose Tissue ◽

Bipolar Voltage

Download Full-text

Opposite relations of epicardial adipose tissue to left atrial size in paroxysmal and permanent atrial fibrillation

SAGE Open Medicine ◽

10.1177/2050312118799908 ◽

2018 ◽

Vol 6 ◽

pp. 205031211879990 ◽

Cited By ~ 4

Author(s):

Stavroula N Psychari ◽

Dionysios Tsoukalas ◽

Dimitrios Varvarousis ◽

Anastasios Papaspyropoulos ◽

Eleni Gkika ◽

...

Keyword(s):

Atrial Fibrillation ◽

Adipose Tissue ◽

Interleukin 6 ◽

Left Atrial ◽

Epicardial Adipose Tissue ◽

High Sensitivity ◽

Left Atrial Size ◽

Reactive Protein ◽

Permanent Atrial Fibrillation ◽

Atrial Size

Objectives: Atrial fibrillation has been associated with obesity in epidemiological studies. Epicardial adipose tissue is an ectopic fat depot in the proximity of atria, with endocrine and inflammatory properties that is implicated in the pathophysiology of atrial fibrillation. Inflammation also has a role in atrial arrhythmogenesis. The aim of this study was to investigate the potential relations of epicardial adipose tissue to left atrial size and to adiponectin and the pro-inflammatory mediators, high-sensitivity C-reactive protein, and interleukin-6 in paroxysmal and permanent atrial fibrillation. Methods: This was a cross-sectional study of 103 atrial fibrillation patients, divided into two subgroups of paroxysmal and permanent atrial fibrillation, and 81 controls, in sinus rhythm. Echocardiography was used for estimation of epicardial adipose tissue and left atrial size and high-sensitivity C-reactive protein, interleukin-6 and adiponectin were measured in all subjects. Results: Atrial fibrillation patients had significantly larger epicardial adipose tissue compared with controls (0.43 ± 0.17 vs 0.34 ± 0.17 cm, p = 0.002). Atrial fibrillation presence was independently related to epicardial adipose tissue thickness ( b = 0.09, p = 0.002). Opposite associations of epicardial adipose tissue with left atrial volume existed in atrial fibrillation subgroups; in the paroxysmal subgroup, epicardial adipose tissue was directly related to left atrial volume ( R = 0.3, p = 0.03), but in the permanent one the relation was inverse ( R = −0.7, p < 0.0001). Adiponectin, high-sensitivity C-reactive protein and interleukin-6 were elevated in both atrial fibrillation groups. Only interleukin-6 was related to epicardial adipose tissue size. Conclusion: Opposite associations of epicardial adipose tissue with left atrial size in paroxysmal and permanent Atrial fibrillation and elevated inflammatory markers, suggest a role of epicardial adipose tissue and inflammation in the fibrotic and remodeling process.

Download Full-text