AF recurrence after catheter ablation is higher in overweight, obese, and morbidly obese patients comparing to normal-weight controls, driven primarily by outcomes differences in paroxysmal AF patients. Complications were not associated with increased BMI.

Patient characteristics reflected in CHA2DS2VASc scoring and early institutional experience predict increased complication rates following AF ablation. Despite more patients with higher CHA2DS2VASc scores undergoing AF ablation, complication rates fell over time as institutional experience increased.

Intra-atrial dyssynchrony during sinus rhythm is an independent predictor of recurrence after the first catheter ablation of paroxysmal or persistent AF. Assessment of intra-atrial dyssynchrony may improve ablation outcomes by refining patient selection.

Background Epicardial adipose tissue (EAdT) is metabolically active and likely contributes to atrial fibrillation (AF) through the release of inflammatory cytokines into the myocardium or through its rich innervation with ganglionated plexi at the pulmonary vein ostia. The electrophysiological mechanisms underlying the association between EAdT and AF remain unclear. Objective Our study investigated the association of EAdT with adjacent myocardial substrate. Methods We studied 30 consecutive patients who underwent cardiac computed tomography as well as electro-anatomical mapping in sinus rhythm prior to an initial AF ablation procedure. Semiautomatic segmentation of atrial EAdT was performed and registered anatomically to the voltage map. Results In multivariable regression analysis clustered by patient, age (−0.01 per year) and EAdT (−0.29) were associated with log bipolar voltage as well as low-voltage zones (<0.5 mV). Age (OR=1.02 per year), male gender (OR=3.50), diabetes (OR=2.91), hypertension (OR=2.55), and EAdT (OR=8.56) were associated with fractionated electrograms and age (OR=2.80), male gender (OR=3.00), and EAdT (OR=7.03) were associated with widened signals. Age (OR=1.03 per year) and BMI (OR=1.06 per kg/m2) were associated with atrial fat. Conclusion The presence of overlaying EAdT was associated with lower bipolar voltage and electrogram fractionation as electrophysiologic substrates for AF. EAdT was not a statistical mediator of the association between clinical variables and AF substrate. BMI was directly associated with the presence of EAdT in patients with AF.

Higher mechanical dyssynchrony of the LA during sinus rhythm is associated with a history of stroke/TIA in patients with AF.

CVA is a rare complication of AF ablation in patients with minimally interrupted anticoagulation. Pre-ablation TEE may be reasonably avoided in patients without high-risk features.

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LGE-MRI, FAM and PBP-mapping show good correlation in delineating electro-anatomical AF substrate. Each approach has fundamental technical characteristics, the awareness of which allows proper assessment of atrial fibrosis.