Periatrial Fat Quality Predicts Atrial Fibrillation Ablation Outcome

Abstract

Background Previous studies showed that the quantity of the left atrial (LA) periatrial fat tissue predicts recurrence after catheter ablation of atrial fibrillation (AF). We hypothesized that the quality of the LA periatrial fat tissue, measured by the mean computed tomography attenuation, predicts recurrence after AF ablation independent of the quantity of the LA periatrial fat tissue. Methods We included 143 consecutive patients with drug-refractory AF referred for the first catheter ablation of AF (62.2±10 years, 40% nonparoxysmal AF). All participants had a preablation cardiac computed tomography. We measured the quantity of the LA periatrial fat tissue by the area (millimeter square) and the quality by the mean computed tomography attenuation (Hounsfield units) in a standard 4-chamber view. Results Patients with AF recurrence after ablation (n=57) had a significantly larger fat area (167.6 [interquartile range, 124.1-255] versus 145.4 [95.6-229.3] mm2; P=0.018) and a higher fat attenuation (-92.0±9.8 versus -96.5±9.4 Hounsfield units; P=0.006) than those without recurrence (controls). LA fat attenuation was correlated with LA fat volume and LA bipolar voltage by invasive mapping and was associated with AF recurrence after adjusting for clinical risk factors, including body mass index, AF type, LA dimension, and fat area (hazard ratio, 2.65; P=0.001). Conclusions The quality of the LA periatrial fat tissue is an independent predictor of recurrence after the first AF ablation. Assessment of LA periatrial fat attenuation can improve AF ablation outcomes by refining patient selection.

Keywords: atrial fibrillation; body mass index; catheter ablation; patient selection; risk factors.

Conflict of interest statement

DISCLOSURE

No authors have any potential conflict of interest to disclose.

Figures

Figure 1.. Quantification of LA periatrial fat area and attenuation using CT.

A, 4-CH view with red contours surrounding the LA. B, 2-CH view with red contours surrounding the LA. CT, computed tomography; CH, chamber. Yellow circle, the left atrial – periesophageal fat pad region captured by the 4-CH view.

Figure 2.. Correlation between 4-CH LA periatrial fat area and 4-CH LA periatrial fat attenuation.

Red dotted lines, the best discriminatory point by Liu criteria for left atrial (LA) fat area and attenuation; Blue circles, patients in the AF Free group; Pink triangle, patients in the recurrence group. Blue line, linear regression line.

Figure 3.. Symptomatic Recurrence Based on Fat Attenuation.

Solid red line, attenuation > −86.98 HU; Broken red line, 95% confidence interval (CI) of attenuation > −86.98 HU; Solid green line, attenuation