Objective: Atrial fibrillation (AF) is the most com-mon supraventricular rhythm disturbance and pul-monary vein (PV) isolation has an important role in rhythm control treatment strategies of this disease. Va-rious anatomical and clinical characteristics have been well established as predictors of the risk of recurrence following ablation procedures, but the role of epicardial fat tissue (EFT) in the recurrence of AF has not been elucidated so far. The study aimed to investigate the in-fluence of left atrial (LA) size and EFT volume in the recurrence of AF after pulmonary vein ablation, during a 6-month follow-up.
Methods: A total of 40 patients, 52.5% with paroxys-mal and 47.5% with chronic AF underwent PV isolati-on using radiofrequency and cryoablation techniques. EFT was determined using cardiac computed tomo-graphy angiography (CCTA) associated with advanced image post-processing techniques.
Results: In patients who developed AF recurrence at 6 months aft er AF ablation, the volume of EFT and of LA were significantly larger than in the group who maintained sinus rhythm (202.5 ± 64.5 ml vs. 138 ± 55.7 ml, p=0.01 for EFT, and 149.3 ± 4.6 ml vs. 90.6 ± 5.1 ml, p<0.0001 for LA volume, respectively). The left ventricular ejection fraction was significantly lower in patients with AF recurrence (50.2 ± 6.5% vs. 54.2 ± 3.9%, p=0.04). Th e analysis of AF recurrence between the two different ablation techniques did not show any difference in recurrence rates between radiofrequency and cryoablation methods (29% vs. 23%, respectively p=0.73). At the same time, recurrence rates aft er AF ablation were not influenced by the main cardiovascular risk factors (age, hypertension, dyslipidemia and smoking) and was not associated with different risk scores (CHA2DS2-VASc and HAS-BLED).
Conclusions: Patients with AF recurrence aft er pulmonary vein ablation present significantly higher EFT or left atrial volumes compared to patients who maintained sinus rhythm. Th is indicates the infl ammatory mediated response, usually accompanied by an increased amount of EFT, could be associated with the risk of AF recurrence following catheter ablation of the pulmonary veins.