Association Between Posterior Left Atrial Adipose Tissue Mass and Atrial Fibrillation

Rosendael, Alexander R. van; Dimitriu-Leen, Aukelien C.; Rosendael, Philippe J. van; Leung, Melissa; Smit, Jeff M.; Saraste, Antti; Knuuti, Juhani; Geest, Rob J. van der; Arend, Britt W H van der; Zwet, Erik W. van; Scholte, Arthur J.; Delgado, Victoria; Bax, Jeroen J.

doi:10.1161/circep.116.004614

Cited by 43 publications

(45 citation statements)

References 28 publications

(34 reference statements)

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“…Our results demonstrate that combined assessment of cine and noncontrast 3D Dixon provides better risk stratification to identify AF patients beyond both the clinical model and LA volume alone. This is supported by a CT study by van Rosendael et al, who reported that posterior LA fat measurement was useful for identifying AF patients . Thus, the integration of LA‐epicardial fat measurement may identify high‐risk populations of AF‐prone patients …”

Section: Discussionmentioning

confidence: 65%

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Left Atrial Epicardial Fat Volume Is Associated With Atrial Fibrillation: A Prospective Cardiovascular Magnetic Resonance 3D Dixon Study

Nakamori

Nezafat

Ngo

et al. 2018

JAHA

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BackgroundRecent studies demonstrated a strong association between atrial fibrillation (AF) and epicardial fat around the left atrium (LA). We sought to assess whether epicardial fat volume around the LA is associated with AF, and to determine the additive value of LA‐epicardial fat measurements to LA structural remodeling for identifying patients with AF using 3‐dimensional multi‐echo Dixon fat–water separated cardiovascular magnetic resonance.Methods and ResultsA total of 105 subjects were studied: 53 patients with a history of AF and 52 age‐matched patients with other cardiovascular diseases but no history of AF. The 3‐dimensional multi‐echo Dixon fat‐water separated sequence was performed for LA‐epicardial fat measurements. AF patients had significantly greater LA‐epicardial fat (28.9±12.3 and 14.2±7.3 mL for AF and non‐AF, respectively; P<0.001) and LA volume (110.8±38.2 and 89.7±30.3 mL for AF and non‐AF, respectively; P=0.002). LA‐epicardial fat adjusted for LA volume was still higher in patients with AF compared with those without AF (P<0.001). LA‐epicardial fat and hypertension were independently associated with the risk of AF (odds ratio, 1.17; 95% confidence interval, 1.10%–1.25%, P<0.001, and odds ratio, 3.29; 95% confidence interval, 1.17%–9.27%, P=0.03, respectively). In multivariable logistic regression analysis adjusted for body surface area, LA‐epicardial fat remained significant and an increase per mL was associated with a 42% increase in the odds of AF presence (odds ratio, 1.42; 95% confidence interval, 1.23%–1.62%, P<0.001). Combined assessment of LA‐epicardial fat and LA volume provided greater discriminatory performance for detecting AF than LA volume alone (c‐statistic=0.88 and 0.74, respectively, DeLong test; P<0.001).ConclusionsCardiovascular magnetic resonance 3‐dimensional Dixon‐based LA‐epicardial fat volume is significantly increased in AF patients. LA‐epicardial fat measured by 3‐dimensional Dixon provides greater performance for detecting AF beyond LA structural remodeling.

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Section: Discussionmentioning

confidence: 65%

“…This is supported by a CT study by van Rosendael et al, who reported that posterior LA fat measurement was useful for identifying AF patients. 32 Thus, the integration of LA-epicardial fat measurement may identify high-risk populations of AF-prone patients. 27 Our study has several limitations.…”

Section: Discussionmentioning

confidence: 99%

Left Atrial Epicardial Fat Volume Is Associated With Atrial Fibrillation: A Prospective Cardiovascular Magnetic Resonance 3D Dixon Study

Nakamori

Nezafat

Ngo

et al. 2018

JAHA

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“…There is a particularly strong relationship between the size of the depot of posterior left atrial adipose tissue and the onset, persistence and recurrence of atrial fibrillation . Additionally, periatrial fat in patients with atrial fibrillation demonstrates genomic signatures that reflect activation of pro‐inflammatory and pro‐fibrotic pathways.…”

Section: Effect Of Epicardial Adipose Inflammation On the Atrial Myocmentioning

confidence: 99%

“…6 There is a particularly strong relationship between the size of the depot of posterior left atrial adipose tissue and the onset, persistence and recurrence of atrial fibrillation. 7 Additionally, periatrial fat in patients with atrial fibrillation demonstrates genomic signatures that reflect activation of pro-inflammatory and pro-fibrotic pathways. Of note, epicardial adipose tissue with the most severe structural and functional derangements resides in close proximity to myocardial foci with the greatest electrophysiological abnormalities.…”

Section: Effect Of Epicardial Adipose Inflammation On the Atrial Myocmentioning

confidence: 99%

The epicardial adipose inflammatory triad: coronary atherosclerosis, atrial fibrillation, and heart failure with a preserved ejection fraction

Packer

2018

European J of Heart Fail

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“…Epicardial adipose tissue (EAT) is a metabolically active tissue located between the visceral pericardium and the epicardium, known as a risk factor for various cardiovascular diseases, 1 particularly atrial fibrillation (AF), to which EAT is closely related. EAT volume is related to both new‐onset AF 2,3 and AF recurrence after catheter ablation 4,5 or cardioversion 6 . Moreover, EAT alters the atrial electrophysiological properties contributing to generate AF 7,8 …”

Section: Introductionmentioning

confidence: 99%

Epicardial adipose tissue affects the efficacy of left atrial posterior wall isolation for persistent atrial fibrillation

Nakatani

Sakamoto

Yamaguchi

et al. 2020

Journal of Arrhythmia

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Background Epicardial adipose tissue (EAT) contributes to atrial fibrillation (AF). However, its impact on the efficacy of left atrial posterior wall isolation (LAPWI) is unclear. Methods Forty‐four nonparoxysmal AF patients underwent LAPWI after pulmonary vein isolation. EAT overlap on LAPWI was assessed by fusing computed tomography images with electro‐anatomical mapping. Results During the 21 ± 7 months of follow‐up, AF recurred in 10 patients (23%). The total and left atrial EAT volumes were 113 ± 36 and 33 ± 12 cm3, respectively. No differences were found between the AF‐free and AF‐recurrent groups regarding EAT volume. The EAT overlaps on LAPWI lines and LAPWI area were 1.2 ± 1.0 and 0.5 ± 0.9 cm2 respectively. Although no difference was found between groups regarding the EAT overlap on LAPWI area, the AF‐free group had a significantly larger EAT overlap on LAPWI lines (1.4 ± 1.0 vs 0.6 ± 0.6 cm2, P = .014). Multivariate analysis identified EAT overlap on LAPWI lines as an independent predictor of AF recurrence (hazard ratio: 0.399, 95% confidence interval: 0.178‐0.891, P = .025). Kaplan‐Meier analysis revealed that, during follow‐up, 92% of the large EAT overlap group (≥1.0 cm2) and 58% of the small EAT overlap group (<1.0 cm2) remained AF‐free (P = .008). Conclusions EAT overlap on LAPWI lines is related to a high AF freedom rate. Direct radiofrequency application to EAT overlap may be necessary to suppress AF.

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Association Between Posterior Left Atrial Adipose Tissue Mass and Atrial Fibrillation

Cited by 43 publications

References 28 publications

Left Atrial Epicardial Fat Volume Is Associated With Atrial Fibrillation: A Prospective Cardiovascular Magnetic Resonance 3D Dixon Study

Left Atrial Epicardial Fat Volume Is Associated With Atrial Fibrillation: A Prospective Cardiovascular Magnetic Resonance 3D Dixon Study

The epicardial adipose inflammatory triad: coronary atherosclerosis, atrial fibrillation, and heart failure with a preserved ejection fraction

Epicardial adipose tissue affects the efficacy of left atrial posterior wall isolation for persistent atrial fibrillation

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