AUTHOR=Kim Daehoon , Yu Hee Tae , Kwon Oh-Seok , Kim Tae-Hoon , Uhm Jae-Sun , Joung Boyoung , Lee Moon-Hyoung , Pak Hui-Nam 

TITLE=Effect of epicardial fat volume on outcomes after left atrial posterior wall isolation in addition to pulmonary vein isolation in patients with persistent atrial fibrillation

JOURNAL=Frontiers in Cardiovascular Medicine

VOLUME=Volume 9 - 2022

YEAR=2022

URL=https://www.frontiersin.org/journals/cardiovascular-medicine/articles/10.3389/fcvm.2022.1005760

DOI=10.3389/fcvm.2022.1005760

ISSN=2297-055X

ABSTRACT=Background: Increased epicardial adipose tissue (EAT) is associated with higher recurrences after atrial fibrillation catheter ablation (AFCA). We investigated the effects of posterior wall box isolation (POBI) in addition to circumferential pulmonary vein isolation (CPVI) on rhythm outcomes with varying epicardial adipose tissue (EAT) volumes in patients with persistent atrial fibrillation (PeAF).
Methods: We included 1,187 patients with PeAF undergoing a de novo AFCA including those receiving CPVI alone (n=687) and those receiving additional POBI (n=500). The rhythm outcomes at two years post-AFCA were compared in subgroups stratified by the EAT volume using propensity overlap weighting.
Results: A reduced EAT volume was linearly associated with more favorable rhythm outcomes for additional POBI than for CPVI alone (P for interaction=0.002). Among the patients with smaller EAT volumes (116.23ml, the median value, n=594), additional POBI was associated with a reduced AF recurrence risk as compared to CPVI only (weighted HR [hazard ratio] 0.74, 95% CI [confidence interval] 0.56–0.99). In contrast, among the remaining 593 patients with greater EAT volumes (>116.23mL), there was no difference in the recurrence risk between the additional POBI and CPVI alone groups (weighted HR 1.13, 95% CI 0.84–1.52). Among 205 patients with repeat ablations, the POBI reconnection rate was significantly higher in the large EAT group (77.4%) than in the small EAT group (56.7%, P=0.034).
Conclusions: While PeAF patients with a smaller EAT volume averted AF recurrence by additional POBI after CPVI, no benefit of the POBI was observed in those with a greater EAT volume.