Does epicardial fat modify the effect of catheter ablation in patients with atrial fibrillation?

Many million patients suffer from atrial fibrillation (AF) [ [1] Hindricks G. Potpara T. Dagres N. et al. ESC guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association of Cardio-Thoracic Surgery (EACTS). Eur. Heart J. 2020; (ehaa612)https://doi.org/10.1093/eurheartj/ehaa612 Crossref Scopus (4032) Google Scholar ]. The occurrence of AF is related to an atrial cardiomyopathy in the majority of patients [ [2] Goette A. Kalman J.M. Aguinaga L. et al. EHRA/HRS/APHRS/SOLAECE expert consensus on atrial cardiomyopathies: definition, characterization, and clinical implication. Europace. 2016; 18: 1455-1490 Crossref PubMed Scopus (397) Google Scholar , [3] Bukowska A. Nikonova Y. Wolke C. Lendeckel U. Kockskämper J. Goette A. Anti-inflammatory effects of endothelin receptor blockade in left atrial tissue of spontaneously hypertensive rats. Int. J. Cardiol. Heart Vasc. 2022; 42101088https://doi.org/10.1016/j.ijcha.2022.101088 Crossref PubMed Scopus (6) Google Scholar ]. Several molecular pathways were described to induce atrial tissue changes [ [4] Goette A. Jentsch-Ullrich K. Lendeckel U. Röcken C. Agbaria M. Auricchio A. Mohren M. Franke A. Klein H.U. Effect of atrial fibrillation on hematopoietic progenitor cells: a novel pathophysiological role of the atrial natriuretic peptide?. Circulation. 2003; 108: 2446-2449 Crossref PubMed Scopus (51) Google Scholar , [5] Goette A. Lendeckel U. Atrial cardiomyopathy: pathophysiology and clinical consequences. Cells. 2021; 10: 2605https://doi.org/10.3390/cells10102605 Crossref PubMed Scopus (21) Google Scholar ]. In particular, the angiotensin II system and inflammatory pathways were found to play a significant role [ [2] Goette A. Kalman J.M. Aguinaga L. et al. EHRA/HRS/APHRS/SOLAECE expert consensus on atrial cardiomyopathies: definition, characterization, and clinical implication. Europace. 2016; 18: 1455-1490 Crossref PubMed Scopus (397) Google Scholar , 4 Goette A. Jentsch-Ullrich K. Lendeckel U. Röcken C. Agbaria M. Auricchio A. Mohren M. Franke A. Klein H.U. Effect of atrial fibrillation on hematopoietic progenitor cells: a novel pathophysiological role of the atrial natriuretic peptide?. Circulation. 2003; 108: 2446-2449 Crossref PubMed Scopus (51) Google Scholar , 5 Goette A. Lendeckel U. Atrial cardiomyopathy: pathophysiology and clinical consequences. Cells. 2021; 10: 2605https://doi.org/10.3390/cells10102605 Crossref PubMed Scopus (21) Google Scholar , 6 Wyse D.G. Waldo A.L. DiMarco J.P. Domanski M.J. Rosenberg Y. Schron E.B. Kellen J.C. Greene H.L. Mickel M.C. Dalquist J.E. Corley S.D. A comparison of rate control and rhythm control in patients with atrial fibrillation. N. Engl. J. Med. 2002; 347: 1825-1833 Crossref PubMed Scopus (3746) Google Scholar , 7 Gorenek B. Pelliccia A. Benjamin E.J. et al. European heart rhythm association (EHRA)/European Association of Cardiovascular Prevention and Rehabilitation (EACPR) position paper on how to prevent atrial fibrillation endorsed by the Heart Rhythm Society (HRS) and Asia Pacific Heart Rhythm Society (APHRS). Eur. J. Prev. Cardiol. 2017; 24: 4-40https://doi.org/10.1177/2047487316676037 Crossref PubMed Scopus (68) Google Scholar ]. Recently, epicardial fat has been described to interact with the myocardium and pericardial fluid. In the atria, epicardial fat also separates myocardial fibers in the atrial wall and may thereby directly influence cardiac conduction [ [8] Chilukoti R.K. Giese A. Malenke W. Homuth G. Bukowska A. Goette A. Felix S.B. Kanaan J. Wollert H.G. Evert K. Verheule S. Jais P. Hatem S.N. Lendeckel U. Wolke C. Atrial fibrillation and rapid acute pacing regulate adipocyte/adipositas-related gene expression in the atria. Int. J. Cardiol. 2015; 187 (Epub 2015 Mar 23. PMID: 25863735): 604-613https://doi.org/10.1016/j.ijcard.2015.03.072 Abstract Full Text Full Text PDF PubMed Scopus (52) Google Scholar ]. Interestingly, fat tissue along the coronary arteries appears as a marker for cardiovascular events. Therefore, it is unclear if the amount of epicardial fat is also related to outcome in patients with AF in particular after catheter ablation. The EAST-AFNET4 trial (The Early Treatment of Atrial Fibrillation for Stroke Prevention Trial) showed that early rhythm control therapy is effective to prevent stroke and cardiovascular death in patients with chronic AF pattern [ [9] Kirchhof P. Camm A.J. Goette A. et al. Early rhythm-control therapy in patients with atrial fibrillation. N. Engl. J. Med. 2020; 383: 1305-1316https://doi.org/10.1056/NEJMoa2019422 Crossref PubMed Scopus (752) Google Scholar ]. The first primary outcome was a composite of death from cardiovascular causes, stroke, or hospitalization with worsening of heart failure or acute coronary syndrome (ACS). The second primary outcome was the number of nights spent in the hospital per year. A recent substudy of the EAST AFNET 4 trial demonstrated that the AF pattern is an easy-to-use marker to identify certain AF groups. Patients presenting with first diagnosed AF (FDAF) did not benefit from early rhythm control therapy with regard to hospitalization and ACS during follow-up [ [10] Goette Borof K. Breithardt G. et al. Presenting pattern of atrial fibrillation and outcomes of early rhythm control therapy. J. Am. Coll. Cardiol. 2022; 80: 283-295 Crossref PubMed Scopus (19) Google Scholar ]. Thus, FDAF must be differentiated from chronic AF patterns like chronic paroxysmal and chronic persistent AF. The predictive value of left atrium epicardial adipose tissue on recurrence after catheter ablation in patients with different types of atrial fibrillationInternational Journal of CardiologyVol. 379PreviewA growing body of evidence supports that the left atrium epicardial adipose tissue (LA-EAT) is related to the occurrence and recurrence of atrial fibrillation (AF). The relationship between LA-EAT and the recurrence after radiofrequency catheter ablation (RFCA) in patients with different types of AF is still unclear. This study aims to evaluate the predictive value of LA-EAT on the recurrence of AF after RFCA in patients with different types of AF. Full-Text PDF