Quantitative analysis of quantity and distribution of epicardial adipose tissue surrounding the left atrium in patients with atrial fibrillation and effect of recurrence after ablation.

Epicardial adipose tissue (EAT) contains ganglionated plexuses and adipocytes that can affect the pathogenesis of atrial fibrillation (AF). The aim of this study was to quantify the EAT surrounding the left atrium (LA) and correlate it with occurrence of AF and outcome after catheter ablation. EAT was evaluated using 64-slice multidetector computed tomography in 68 patients with AF and 34 controls. EAT volume was acquired by semiautomatically tracing axial images from the pulmonary artery to the coronary sinus. Topographic distribution of EAT was assessed by dividing the periatrial space into 8 equal regions. EAT volume significantly increased in patients with AF than in controls (29.9 ± 12.1 vs 20.2 ± 6.5 cm(3), p <0.001). Most EAT was located in regions (1) within the superior vena cava, right pulmonary artery, and right-sided roof of the LA (29.8%), (2) within the aortic root, pulmonary trunk, and left atrial appendage (26.5%), and (3) between the left inferior pulmonary vein and left atrioventricular groove (18.1%). Baseline variables were analyzed in patients with (n = 24) and without (n = 44) AF recurrence after ablation. The recurrent group showed significantly increased EAT (35.2 ± 12.5 vs 26.8 ± 11.1 cm(3), p = 0.007). Multivariate analysis revealed that EAT was an independent predictor of AF recurrence after ablation (p = 0.038). In conclusion, EAT of LA was increased in patients with AF. Large clusters of EAT were observed adjacent to the anterior roof, left atrial appendage, and lateral mitral isthmus. Abundance of EAT was independently related to AF recurrence after ablation.

[1]  L. Lo,et al.  Prognostic implications of the high-sensitive C-reactive protein in the catheter ablation of atrial fibrillation. , 2010, The American journal of cardiology.

[2]  L. Lo,et al.  Predicting factors for atrial fibrillation acute termination during catheter ablation procedures: implications for catheter ablation strategy and long-term outcome. , 2009, Heart rhythm.

[3]  A. Montoya,et al.  Topography of cardiac ganglia in the adult human heart. , 1996, The Journal of thoracic and cardiovascular surgery.

[4]  O. Alfieri,et al.  Pulmonary Vein Denervation Enhances Long-Term Benefit After Circumferential Ablation for Paroxysmal Atrial Fibrillation , 2004, Circulation.

[5]  Carl D Langefeld,et al.  Pericardial and Visceral Adipose Tissues Measured Volumetrically With Computed Tomography Are Highly Associated in Type 2 Diabetic Families , 2005, Investigative radiology.

[6]  Cheng-Yen Chang,et al.  The role of left atrial muscular bundles in catheter ablation of atrial fibrillation. , 2007, Journal of the American College of Cardiology.

[7]  L. Shyu,et al.  Assessment of left atrial function using multi-slice CT images , 2007, 2007 Computers in Cardiology.

[8]  H. Sacks,et al.  Human epicardial adipose tissue: a review. , 2007, American heart journal.

[9]  Paul Schoenhagen,et al.  Left Atrial Epicardial Adiposity and Atrial Fibrillation , 2010, Circulation. Arrhythmia and electrophysiology.

[10]  F. Leonetti,et al.  Echocardiographic epicardial adipose tissue is related to anthropometric and clinical parameters of metabolic syndrome: a new indicator of cardiovascular risk. , 2003, The Journal of clinical endocrinology and metabolism.

[11]  R. Lazzara,et al.  Autonomic Elements within the Ligament of Marshall and Inferior Left Ganglionated Plexus Mediate Functions of the Atrial Neural Network , 2009, Journal of cardiovascular electrophysiology.

[12]  J. Takasu,et al.  Pericardial fat accumulation in men as a risk factor for coronary artery disease. , 2001, Atherosclerosis.

[13]  Evgeny Pokushalov,et al.  Selective ganglionated plexi ablation for paroxysmal atrial fibrillation. , 2009, Heart rhythm.

[14]  Udo Hoffmann,et al.  Pericardial Fat Is Associated With Prevalent Atrial Fibrillation: The Framingham Heart Study , 2010, Circulation. Arrhythmia and electrophysiology.

[15]  The Impact of Catheter Ablation on the Dynamic Function of the Left Atrium in Patients with Atrial Fibrillation: Insights from Four‐Dimensional Computed Tomographic Images , 2010, Journal of cardiovascular electrophysiology.

[16]  R. Bonser,et al.  Human epicardial adipose tissue expresses a pathogenic profile of adipocytokines in patients with cardiovascular disease , 2006, Cardiovascular diabetology.

[17]  J. Cummings,et al.  Preservation of the anterior fat pad paradoxically decreases the incidence of postoperative atrial fibrillation in humans. , 2004, Journal of the American College of Cardiology.

[18]  Frederick T. Han,et al.  Results of a Minimally Invasive Surgical Pulmonary Vein Isolation and Ganglionic Plexi Ablation for Atrial Fibrillation: Single-Center Experience With 12-Month Follow-Up , 2009, Circulation. Arrhythmia and electrophysiology.

[19]  Shyi-Jang Shin,et al.  Increased epicardial adipose tissue (EAT) volume in type 2 diabetes mellitus and association with metabolic syndrome and severity of coronary atherosclerosis , 2009, Clinical endocrinology.

[20]  Udo Hoffmann,et al.  Pericardial Fat, Intrathoracic Fat, and Measures of Left Ventricular Structure and Function: The Framingham Heart Study , 2009, Circulation.

[21]  Udo Hoffmann,et al.  Pericardial Fat, Visceral Abdominal Fat, Cardiovascular Disease Risk Factors, and Vascular Calcification in a Community-Based Sample: The Framingham Heart Study , 2008, Circulation.

[22]  J. Shirani,et al.  Clinical significance of epicardial fat measured using cardiac multislice computed tomography. , 2008, The American journal of cardiology.

[23]  D. Wilber,et al.  Pericardial fat is independently associated with human atrial fibrillation. , 2010, Journal of the American College of Cardiology.

[24]  W. Roberts,et al.  Quantitative measurement of normal and excessive (cor adiposum) subepicardial adipose tissue, its clinical significance, and its effect on electrocardiographic QRS voltage. , 1995, The American journal of cardiology.

[25]  L. Lo,et al.  The Impact of Age on the Electroanatomical Characteristics and Outcome of Catheter Ablation in Patients with Atrial Fibrillation , 2010, Journal of cardiovascular electrophysiology.

[26]  H. Nakagawa,et al.  Localization of Left Atrial Ganglionated Plexi in Patients with Atrial Fibrillation , 2009, Journal of cardiovascular electrophysiology.