Abstract 13583: Pericardial Adiposity Predicts Atrial Fibrillation Recurrence Following Catheter Ablation
Introduction: Obesity is recognised as a risk factor for developing atrial fibrillation (AF). Novel predictors of catheter ablation outcomes may improve selection for this invasive therapy. AIM We investigated the impact of the 3 local pericardial fat depots; periatrial, periventricular and total pericardial, on AF recurrence following catheter ablation.
Methods: One hundred and two highly symptomatic patients with AF underwent cardiac magnetic resonance imaging (1.5 Tesla, steady state free precession short axis cines) in the week prior to a first-time catheter ablation. Periatrial, periventricular and total pericardial fat volumes were measured offline by 2 blinded observers using a method previously described and validated ex-vivo in an ovine model. Conventional AF risk factors were recorded for the study subjects. Ablation was performed by blinded physicians utilizing pulmonary vein isolation and further substrate modification depending on duration of AF and presence of structural heart disease. Follow-up, using 7-day Holter and clinical interviews, was done at 3 monthly intervals up to 24 months post ablation.
Results: Patients were divided into tertiles according to pericardial fat volume and Kaplan-Meier methods employed. Patients with greater pericardial fat burdens suffered recurrence at earlier time points after the index ablation procedure than those with less pericardial fat (p=0.035 by log rank test). Each of the three local fat depots were individually predictive of AF recurrence by Cox regression modelling. Periventricular fat volume remained predictive following multivariable adjustment (p=0.024) and further adjustment for body weight (p=0.025). Body mass index and body surface area were not predictive of AF recurrence.
Conclusion: Local pericardial fat burden predicts AF recurrence following catheter ablation over and above any effect of systemic adiposity. This supports a local influence of this tissue on the arrhythmia substrate.
- © 2010 by American Heart Association, Inc.