Left Atrial Epicardial Adiposity and Atrial Fibrillation

Abstract

Background-Atrial fibrillation (AF) has been linked to inflammatory factors and obesity. Epicardial fat is a source of several inflammatory mediators related to the development of coronary artery disease. We hypothesized that periatrial fat may have a similar role in the development of AF. Methods and Results-Left atrium (LA) epicardial fat pad thickness was measured in consecutive cardiac CT angiograms performed for coronary artery disease or AF. Patients were grouped by AF burden: no (nϭ73), paroxysmal (nϭ60), or persistent (nϭ36) AF. In a short-axis view at the mid LA, periatrial epicardial fat thickness was measured at the esophagus (LA-ESO), main pulmonary artery, and thoracic aorta; retrosternal fat was measured in axial view (right coronary ostium level). LA area was determined in the 4-chamber view. LA-ESO fat was thicker in patients with persistent AF versus paroxysmal AF (Pϭ0.011) or no AF (Pϭ0.003). LA area was larger in patients with persistent AF than paroxysmal AF (Pϭ0.004) or without AF (PϽ0.001). LA-ESO was a significant predictor of AF burden even after adjusting for age, body mass index, and LA area (odds ratio, 5.30; 95% confidence interval, 1.39 to 20.24; Pϭ0.015).A propensity score-adjusted multivariable logistic regression that included age, body mass index, LA area, and comorbidities was also performed and the relationship remained statistically significant (Pϭ0.008). Conclusions-Increased

Clinical and histological predictive risk factors of atrial fibrillation in patients undergoing open-heart surgery

“…Al Chekakie et al (24) and Batal et al (25), referring to the association between pericardial fat volume and AF, suggested that the local effects of proinflammatory cytokines released from the pericardial adipose tissue may be a potential mechanism for the development of AF.…”

Role of Epicardial Adipose Tissue in Atrial Fibrillation

“…8 They demonstrate a close association between peri-atrial EAT volume and the development of new-onset AF, independent of the presence of hypertension, diabetes, or LA enlargement, although a recent study demonstrated that, among several types of epicardial fat, only peri-atrial epicardial fat thickness at the esophagus was associated with AF burden independent of age, body mass index, or LA area. 9 Nakanishi et al have demonstrated for the first time that peri-atrial EAT volume predicted future AF events more accurately than total EAT volume during follow-up of 3.3±1.0 years. 8 These results suggest the potential role of peri-atrial EAT in the development of AF.…”

Inflammation of left atrial epicardial adipose tissue is associated with paroxysmal atrial fibrillation

“…Our study targeted EAT surrounding the LA because the LA plays an important role in AF, particularly around the pulmonary veins. We identified sites of EAT anatomically, corresponding to five major LA GPs based on reports of the autonomic innervation of the heart [8,16,17]. In fact, EAT around the LA was found in these five major GP regions.…”

“…Epicardial adipose tissue (EAT) is ectopic visceral fat that surrounds the heart, and increased EAT volumes correlate with the prevalence of AF, as well as with the recurrence of AF after ablation therapy [6,7]. Increased fat thickness at the posterior left atrium (LA) may be particularly related to the AF burden, independent of age, BMI, and the LA area [8,9]. Nevertheless, the mechanisms of AF pathogenesis and the formations of AF substrate due to EAT are not well understood.…”