Epicardial Adipose Tissue in the Right Atrium Is Associated with Progression of Atrial Fibrillation and Recurrence after Pulmonary Vein Catheter Ablation in Patients with Atrial Fibrillation

An increase in epicardial adipose tissue(EAT)in the left atrium(LA) predicts the progression of atrial brillation(AF)and AF recurrence after pulmonary vein catheter ablation(CA). We hypothesized that EAT in the right atrium (RA)is also associated with the progression of AF and post-CA AF recurrence. Using 128-slice multidetector computed tomography, EAT volume and atrial volume were measured 3-dimensionally before CA in 68 patients who had proven AF(paroxysmal AF, 42; persistent AF, 26; mean age, 65±11 years; 42.6% female)with successful CA and 21 volunteers with sinus rhythm(age, 63±13 years; 52.3% female). In both atria, EAT and atrial volumes were largest in patients with persistent AF, followed, in order, by those with paroxysmal AF, and then healthy volunteers(P <0.001). Increased EAT and atrial volumes in both atria predicted persistent AF (P<0.001). Fifteen patients had AF recurrence(22.1%)during the 2-year period after CA. Increased EAT volume in both atria were independent predictors for AF recurrence, and a RA EAT volume ≥ 6.2ml was an independent predictor, with a hazard ratio of 5.47(95% con dence interval, 1.2-24.3; P=0.03). The combination of EAT and atrial volume in both atria was a more powerful independent prognostic factor, with a hazard ratio of 4.8(95% confidence interval, 1.7-3.7; P=0.003), and a sensitivity of 60% in 9 of 15 patients, and speci city of 81.1% in 43 of 53 patients,(P=0.003). RA EAT is associated with the progression of AF and post-CA AF recurrence.