LA Epicardial Adipose Tissue Assessed by CTA Associated With Silent Cerebral Infarcts in Patients With AF Catheter Ablation.

Introduction: Left atrium epicardial adipose tissue (LA-EAT) is an atrial cardiomyopathy marker associated with ischemic stroke. However, the relationship between EAT and silent cerebral infarcts (SCI) is unclear. This study investigated the effect of EAT on the risk of SCI after atrial fibrillation catheter ablation (AFCA).

Methods: This was a single-center prospective study. We consecutively enrolled patients who underwent AFCA from October 2019 to February 2024. All patients completed brain magnetic resonance imaging (MRI) within 24-48 h after AFCA. SCI was defined as new single or multiple brain injuries detectable on MRI without clinical manifestations or neurolocalization signs.

Results: A total of 341 patients were enrolled, including 56 (16.4%) with SCI. Pearson correlation analysis showed that LA-EAT volume index moderately correlated with left atrial volume index (r = 0.391, p < 0.001). After adjusting for potential confounding factors, multivariate analysis showed that LA-EAT volume index (OR = 1.10; 95% CI: 1.03-1.16, p = 0.002) and LA-EAT attenuation (OR = 1.08; 95% CI: 1.03-1.14, p = 0.003) were independent factors for SCI after AFCA. Integrating LA-EAT volume index and LA-EAT attenuation could statistically improve the ability of the model to predict SCI after AFCA (NRI 0.763, 95% CI: 0.5054-1.0196, p < 0.001; IDI 0.043, 95% CI: 0.0133-0.0733, p = 0.005).

Conclusion: LA-EAT is associated with SCI after AFCA and larger LA-EAT volume is an independent risk factor for SCI. Integrating LA-EAT can statistically improve the risk assessment model for SCI after AFCA.