Skip to main content
SpringerLink
Log in

Epicardial fat and the risk of atrial tachy-arrhythmia recurrence post pulmonary vein isolation: a computed tomography study

  • Original Paper
  • Published:
The International Journal of Cardiovascular Imaging Aims and scope Submit manuscript

Abstract

Epicardial and Pericardia fat have been hypothesized to exert local and systemic pathogenic effects on nearby cardiac structures. The present study aimed to evaluate the impact of epicardial and pericardial fat volumes on the outcome of patients that underwent a first pulmonary vein isolation (PVI) with cryoablation. We included 130 consecutive patients with atrial fibrillation (AF) that underwent contrast enhanced ECG-gated cardiac computed tomography (CCT) before a PVI. The control group included 50 patients in normal sinus rhythm that underwent ECG-gated CT to rule out coronary artery disease. Epicardial and pericardial fat volumes were quantified with CCT. Patients with AF compared to patients with normal sinus rhythm (control group) had significantly larger epicardial (140.3 ± 58.1 vs. 55.9 ± 17.7 ml; respectively, P < 0.001) and pericardial (77.0 ± 35.5 ml vs. 27.2 ± 9.5 ml; respectively, P < 0.001) fat volumes. Among patients that underwent PVIs, those with AF recurrence had a greater epicardial (175.0 ± 54.4 ml vs. 130.7 ± SD 54.2 ml; respectively, P < 0.001) and pericardial (93.7 ± SD 42.8 vs. 72.5 ± SD 31.9 ml; respectively, P < 0.001) fat volumes, compared to patients with no AF recurrence. Multivariate analyses revealed that epicardial fat was an independent predictor of recurrence post-ablation (HR = 1.08, 95% CI 1.02–1.16 per 10-ml increase in volume; P = 0.009). Pericardial fat was associated with 7% increase in risk of recurrent AF (HR = 1.07, 95% CI 0.98–1.18; P = 0.117). Epicardial fat, assessed with contrast enhanced CCT, is an independent predictor of AF recurrence after PVI ablation.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Flegal KM, Carroll MD, Ogden CL, Johnson CL (2002) Prevalence and trends in obesity among U.S. adults, 1999–2000. JAMA 288:1723–1727

    Article  Google Scholar 

  2. Hruby A, Hu FB (2015) The epidemiology of obesity: a big picture. PharmacoEconomics 33:673–689

    Article  Google Scholar 

  3. Wang TJ, Parise H, Levy D, D’Agostino RB Sr, Wolf PA, Vasan RS et al (2004) Obesity and the risk of new-onset atrial fibrillation. JAMA 292:2471–2477

    Article  CAS  Google Scholar 

  4. Schnabel RB, Yin X, Gona P, Larson MG, Beiser AS, McManus DD et al (2015) 50-year trends in atrial fibrillation prevalence, incidence, risk factors, and mortality in the Framingham heart study: a cohort study. Lancet 386:154–162

    Article  Google Scholar 

  5. Wong CX, Sullivan T, Sun MT, Mahajan R, Pathak RK, Middeldorp ME et al (2015) Obesity and the risk of incident, post-operative, and post-ablation atrial fibrillation: a meta-analysis of 626,603 individuals in 51 studies. JACC Clin Electrophysiol 1:139–152

    Article  Google Scholar 

  6. Al Chekakie M, Obadah Christine CW, Raymond Metoyer, Ibrahim A, Shapira AR, Cytron J et al (2010) Pericardial fat is independently associated with human atrial fibrillation. J Am Coll Cardiol 56(10):784–788

    Article  Google Scholar 

  7. Munger TM, Dong Y-X, Masaki M, Oh JK, Mankad SV, Borlaug BA et al (2012) Electrophysiological and hemodynamic characteristics associated with obesity in patients with atrial fibrillation. J Am Coll Cardiol 60(9):851–860

    Article  Google Scholar 

  8. Thanassoulis G, Massaro JM, O’Donnell CH, Hoffmann U, Levy D, Ellinor PT et al (2010) Pericardial fat is associated with prevalent atrial fibrillation: the Framingham heart study. Circ Arrhythm Electrophysiol 3(4):345–350

    Article  Google Scholar 

  9. Calkins H, Hindricks G, Cappato R, Hoon Kim Y, Saad EB, Aguinaga L et al (2017) 2017 HRS/EHRA/ECAS/APHRS/SOLAECE expert consensus statement on catheter and surgical ablation of atrial fibrillation. Heart Rhythm 14:e275–e444

    Article  Google Scholar 

  10. Wong CX, Abed HS, Molaee P, Nelson AJ, Brooks AG, Sharma G et al (2011) Pericardial fat is associated with atrial fibrillation severity and ablation outcome. J Am Coll Cardiol 57:1745–1751

    Article  Google Scholar 

  11. January CT, Wann LS, Alpert JS, Calkins H, Cleveland JC, Cigarroa JE et al (2014) 2014 AHA/ACC/HRS guideline for the management of patients with atrial fibrillation: a report of the American College of Cardiology/American heart association task force on practice guidelines and the heart rhythm society. Circulation 130:e199–e267

    PubMed  PubMed Central  Google Scholar 

  12. Wazni OM, Dandamudi G, Sood N, Hoyt R, Tyler J, Durrani S, on behalf of the STOP-AF First Trial Investigators et al (2021) Cryoballoon Ablation as Initial Therapy for Atrial Fibrillation. N Engl J Med 384:316–324

    Article  CAS  Google Scholar 

  13. Mahabadi AA, Lehmann N, Kalsch H, Bauer M, Dykun I, Kara K et al (2014) Association of epicardial adipose tissue and left atrial size on non-contrast CT with atrial fibrillation: the Heinz Nixdorf Recall Study. Eur Heart J Cardiovasc Imaging 15:863–869

    Article  Google Scholar 

  14. Mahajan R, Lau DH, Brooks AG, Shipp NJ, Manavis J, Wood JP et al (2015) Electrophysiological, electroanatomical, and structural remodeling of the atria as consequences of sustained obesity. J Am Coll Cardiol 66:1–11

    Article  CAS  Google Scholar 

  15. Nagashima K, Okumura Y, Watanabe I, Nakai T, Ohkubo K, Kofune T et al (2011) Association between epicardial adipose tissue volumes on 3-dimensional reconstructed CT images and recurrence of atrial fibrillation after catheter ablation. Circ J 75:2559–2565

    Article  CAS  Google Scholar 

  16. Sacks HS, Fain JN (2007) Human epicardial adipose tissue: a review. Am Heart J 153:907–917

    Article  CAS  Google Scholar 

  17. Wong CX, Ganesan AN, Selvanayagam JB (2017) Epicardial fat and atrial fibrillation: current evidence, potential mechanisms, clinical implications, and future directions. Eur Heart J 38:1294–1302

    Article  CAS  Google Scholar 

  18. Mahajan R, Nelson A, Pathak RK, Nakai T, Ohkubo K, Kofune M et al (2018) Electroanatomical remodeling of the atria in obesity: impact of adjacent epicardial fat. JACC Clin Electrophysiol 4(12):1529–1540

    Article  Google Scholar 

  19. Venteclef N, Guglielmi V, Balse E, Gaborit B, Cotillard A, Atassi F et al (2015) Human epicardial adipose tissue induces fibrosis of the atrial myocardium through the secretion of adipo-fibrokines. Eur Heart J 36:795–805

    Article  CAS  Google Scholar 

  20. Haemers P, Hamdi H, Guedj K, Suffee N, Farahmand P, Popovic N et al (2017) Atrial fibrillation is associated with the fibrotic remodelling of adipose tissue in the subepicardium of human and sheep atria. Eur Heart J 38:53–61

    Article  CAS  Google Scholar 

  21. Nalliah CJ, Bell JR, Raaijmakers AJA, Waddell HM, Wells SP, Bernasoch GB et al (2020) Epicardial adipose tissue accumulation confers atrial conduction abnormality. J Am Coll Cardiol 76:1197–1211

    Article  CAS  Google Scholar 

  22. Nagashima K, Okumura Y, Watanabe I, Nakai T, Ohkubo K, Kofune M et al (2012) Does location of epicardial adipose tissue correspond to endocardial high dominant frequency or complex fractionated atrial electrogram sites during atrial fibrillation? Circ Arrhythm Electrophysiol 5:676–683

    Article  Google Scholar 

  23. Nakahara S, Hori Y, Kobayashi S, Sakai Y, Taguchi I, Takayanagi K et al (2014) Epicardial adipose tissue- based defragmentation approach to persistent atrial fibrillation: its impact on complex fractionated electrograms and ablation outcome. Heart Rhythm 11:1343–1351

    Article  Google Scholar 

Download references

Author information

Author notes

  1. GustavoR. Goldenberg and Ashraf Hamdan contributed equally to the manuscript.

Authors and Affiliations

  1. Cardiology Department, Israel and Sackler Faculty of Medicine, Rabin Medical Center, Tel Aviv University, Tel Aviv, Israel

    Gustavo R. Goldenberg, Ashraf Hamdan, Alon Barsheshet, Ehud Kadmon, Hagai Yavin, Alex Omelchenko, Aharon Erez, Ilan Marcuschamer, Ran Kornowski, Boris Strasberg & Gregory Golovchiner

  2. UT Southwestern Medical Center, Dallas, TX, USA

    Ian Neeland

  3. Electrophysiology and Pacing Unit, Department of Cardiology, Rabin Medical Center, Ze’ev Jabotinsky St 39, 4941492, Petah Tikva, Israel

    Gustavo R. Goldenberg, Alon Barsheshet, Ehud Kadmon, Alex Omelchenko, Aharon Erez, Boris Strasberg & Gregory Golovchiner

Authors
  1. Gustavo R. Goldenberg
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Ashraf Hamdan
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Alon Barsheshet
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Ian Neeland
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Ehud Kadmon
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Hagai Yavin
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Alex Omelchenko
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Aharon Erez
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Ilan Marcuschamer
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Ran Kornowski
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Boris Strasberg
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Gregory Golovchiner
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Gustavo R. Goldenberg.

Ethics declarations

Conflict of interest

Alon Barsheshet has received speaker honoraria from Boehringer Ingelheim, Pfizer, and Bayer. Gregory Golvochiner: Honoraria for proctoring. Educational grant. Medtronic. Rest of the authors have no competing interests.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Goldenberg, G.R., Hamdan, A., Barsheshet, A. et al. Epicardial fat and the risk of atrial tachy-arrhythmia recurrence post pulmonary vein isolation: a computed tomography study. Int J Cardiovasc Imaging 37, 2785–2790 (2021). https://doi.org/10.1007/s10554-021-02244-w

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10554-021-02244-w

Keywords

Search

Navigation