title: Location of epicardial adipose tissue affects the efficacy of a combined dominant frequency and complex fractionated atrial electrogram ablation of atrial fibrillation.
abstract: BACKGROUND
  Epicardial adipose tissue (EAT) is located adjacent to high dominant frequency (DF) sites.
  
  
  OBJECTIVE
  This study aimed to clarify the relationship between the EAT location and efficacy of a combined high DF site and continuous complex fractionated activation electrogram (CFAE) site ablation.
  
  
  METHODS
  Fifty-five patients with nonparoxysmal atrial fibrillation (AF) (26 (47%) persistent and 29 (53%) long-standing persistent) underwent pulmonary vein isolation followed by high DF site and continuous CFAE site ablation. High DF sites (DF ≥8 Hz) and continuous CFAE sites (fractionated intervals ≤50 ms) were targeted. The patients were divided into an AF-free group and an AF-recurrent group.
  
  
  RESULTS
  The AF freedom rate on antiarrhythmic drugs in patients with persistent and long-standing persistent AF was 88.5% and 75.9% over a 12-month follow-up period, respectively. The total EAT, left atrial (LA)-EAT, and right atrial (RA)-EAT volumes did not indicate significant differences between the AF-free and AF-recurrent groups. In the LA, the overlap between high DF sites and EAT was larger in the AF-free group than in the AF-recurrent group (57.0% ± 33.3% vs 22.6% ± 23.3%; P < .01). However, this overlap did not differ between the AF-free and AF-recurrent groups in the RA (20.4% ± 28.2% vs 19.0% ± 24.4%; P = .91). The overlap between continuous CFAE sites and EAT did not differ between the 2 groups in both the LA and the RA.
  
  
  CONCLUSIONS
  High DF sites that overlap with EAT may be important sources of AF. However, the contribution of EAT to the AF substrate may differ between the LA and the RA.
authors.affiliation: Division of Cardiology, Gunma Prefectural Cardiovascular Center, Gunma, Japan.
authors.forename: Yosuke
authors.initials: Y
authors.lastname: Nakatani
authors.affiliation: Division of Cardiology, Gunma Prefectural Cardiovascular Center, Gunma, Japan. Electronic address: kkumagai4917@yahoo.co.jp.
authors.forename: Koji
authors.initials: K
authors.lastname: Kumagai
authors.affiliation: Division of Cardiology, Gunma Prefectural Cardiovascular Center, Gunma, Japan.
authors.forename: Kentaro
authors.initials: K
authors.lastname: Minami
authors.affiliation: Division of Cardiology, Gunma Prefectural Cardiovascular Center, Gunma, Japan.
authors.forename: Masahiro
authors.initials: M
authors.lastname: Nakano
authors.affiliation: Second Department of Internal Medicine, University of Toyama, Toyama, Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Inoue
authors.affiliation: Division of Cardiology, Gunma Prefectural Cardiovascular Center, Gunma, Japan.
authors.forename: Shigeru
authors.initials: S
authors.lastname: Oshima
mesh_terms: D000273:Adipose Tissue / Q000000981:diagnostic imaging*; D001281:Atrial Fibrillation / Q000000981:diagnostic imaging* / Q000503:physiopathology / Q000601:surgery; D017115:Catheter Ablation; D022062:Electrophysiologic Techniques, Cardiac; D005260:Female; D005500:Follow-Up Studies; D006325:Heart Atria / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D006329:Heart Conduction System / Q000000981:diagnostic imaging / Q000503:physiopathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010496:Pericardium / Q000000981:diagnostic imaging*; D011859:Radiography; D012189:Retrospective Studies
keywords: Ablation; Atrial fibrillation; Dominant frequency