title: Epicardial adipose tissue-based defragmentation approach to persistent atrial fibrillation: its impact on complex fractionated electrograms and ablation outcome.
abstract: BACKGROUND
  Increased epicardial adipose tissue (EAT) volume is associated with atrial fibrillation (AF). However, the efficacy of EAT-based left atrial (LA) ablation for persistent AF (PsAF) is unclear.
  
  
  OBJECTIVE
  The purpose of this study was to assess whether EAT-based LA ablation is effective for PsAF.
  
  
  METHODS
  In 60 PsAF patients (group I), 3-dimensional reconstructed computed tomography images depicting EAT were merged with NavX-based dominant-frequency (DF) and complex fractionated electrogram (CFE) maps obtained during AF. Pulmonary vein antrum isolation (PVAI) was followed by map-guided EAT-based ablation. Results were compared to those in a historical control group (group II, case-matched patients who underwent generalized stepwise ablation including linear plus CFE-targeted ablation).
  
  
  RESULTS
  In 70% (n = 42) of group I patients, the LA-EAT was located at the pulmonary vein antra; anterior and inferior surfaces, roof, septum, and mitral annulus; and left atrial appendage. EAT was at or near (<3 mm) 71% (390/550) of high-DF (> -8 Hz) sites. In 41 patients with persistent AF despite EAT-targeted ablation, CFE burden decreased significantly (from 96% to 13%, P < .0001), and DF decreased within the coronary sinus (6.9 ± 0.7 Hz vs 5.9 ± 0.7 Hz, P < .0001). Radiofrequency energy duration was significantly less in group I than in group II (25 ± 6 minutes vs 31 ± 12 minutes, P < .05). During 16-month follow-up, freedom from AF on antiarrhythmic drugs was 78% vs 60% (P < .05).
  
  
  CONCLUSIONS
  PVAI plus EAT-based ablation efficiently eliminates high-frequency sources and yields relatively high success. EAT-based LA ablation is a simple, clinically feasible PsAF ablation strategy.
authors.affiliation: Department of Cardiology, Dokkyo Medical University Koshigaya Hospital, Saitama, Japan. Electronic address: nshiro@dokkyomed.ac.jp.
authors.forename: Shiro
authors.initials: S
authors.lastname: Nakahara
authors.affiliation: Department of Cardiology, Dokkyo Medical University Koshigaya Hospital, Saitama, Japan.
authors.forename: Yuichi
authors.initials: Y
authors.lastname: Hori
authors.affiliation: Department of Cardiology, Dokkyo Medical University Koshigaya Hospital, Saitama, Japan.
authors.forename: Sayuki
authors.initials: S
authors.lastname: Kobayashi
authors.affiliation: Department of Cardiology, Dokkyo Medical University Koshigaya Hospital, Saitama, Japan.
authors.forename: Yoshihiko
authors.initials: Y
authors.lastname: Sakai
authors.affiliation: Department of Cardiology, Dokkyo Medical University Koshigaya Hospital, Saitama, Japan.
authors.forename: Isao
authors.initials: I
authors.lastname: Taguchi
authors.affiliation: Department of Cardiology, Dokkyo Medical University Koshigaya Hospital, Saitama, Japan.
authors.forename: Kan
authors.initials: K
authors.lastname: Takayanagi
authors.affiliation: Division of Cardiology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan.
authors.forename: Koichi
authors.initials: K
authors.lastname: Nagashima
authors.affiliation: Division of Cardiology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan.
authors.forename: Kazumasa
authors.initials: K
authors.lastname: Sonoda
authors.affiliation: Division of Cardiology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan.
authors.forename: Rikitake
authors.initials: R
authors.lastname: Kogawa
authors.affiliation: Division of Cardiology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan.
authors.forename: Naoko
authors.initials: N
authors.lastname: Sasaki
authors.affiliation: Division of Cardiology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan.
authors.forename: Ichiro
authors.initials: I
authors.lastname: Watanabe
authors.affiliation: Division of Cardiology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan.
authors.forename: Yasuo
authors.initials: Y
authors.lastname: Okumura
mesh_terms: D000273:Adipose Tissue / Q000000981:diagnostic imaging*; D001281:Atrial Fibrillation / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D017115:Catheter Ablation / Q000379:methods*; D004562:Electrocardiography; D022062:Electrophysiologic Techniques, Cardiac / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006325:Heart Atria / Q000503:physiopathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D061330:Multidetector Computed Tomography; D010496:Pericardium / Q000000981:diagnostic imaging / Q000503:physiopathology*; D016896:Treatment Outcome
keywords: Atrial fibrillation; Complex fractionated electrogram; Dominant frequency; EAT-based left atrial ablation; Epicardial adipose tissue