Association between epicardial adipose tissue and recurrence after atrial fibrillation catheter ablation

Abstract Introduction In patients (pts) undergoing atrial fibrillation (AF) catfheter ablation, up to one third have recurrence of atrial fibrillation after a first ablation. Epicardial adipose tissue (EAT) is closely related to AF and could play a role in the recurrence of AF after catheter ablation. Objectives To analyze the association between EAT and recurrence of AF in pts submitted to ablation. Methods Single-center retrospective study of consecutive AF pts submitted to ablation between 2011 and 2020, with, at least, one-year follow-up. Epidemiological, clinical, laboratory, echo and angio-CT related data were retrieved. A standardized protocol for quantification of EAT, thoracic adipose volume (TAV) and left atrium volume (LAV) was performed. After comparison of groups using Chi-square and Mann-Whitney analysis, an appropriate Cut Off of EAT for our population was determined, and Kaplan Meier survival curves were used to estimate the risk of events (recurrence of AF). Results 344 pts (63.1% men) were included, with a mean age of 57.4±10.9 years and a median follow-up time of 22 months. During follow-up, 31.,7% (n=109) of pts had recurrence of AF. Baseline characteristics were similar between groups, except for persistent AF, which was higher in pts with recurrence (25% vs 46%, p=0.011). Recurrence of AF was associated with a higher EAT (p=0.040) and a higher LAV (p<0.001) but not with TAV (p=0.115) nor body mass index (BMI) (p=0.123). In pts with recurrence, values of EAT above a cut-off of 151 cm3 predict the endpoint of time to recurrence (HR 2.05, CI [1.180–3.566], p=0.01), with these pts presenting a median of 11 months survival free from recurrence, comparing to a median of 15 months in pts with EAT values bellow the aforementioned cut-off (log-rank p=0.008). Conclusion EAT was predictor of AF recurrence in our population, with pts with a EAT value >151 cm3 presenting a statistically significant lower survival free from recurrence. Funding Acknowledgement Type of funding sources: None.