title: Periatrial epicardial adipose tissue thickness is an independent predictor of atrial fibrillation recurrence after cryoballoon-based pulmonary vein isolation.
abstract: BACKGROUND
  Epicardial adipose tissue (EAT) is a metabolically active fat depot. Studies have investigated the effect of EAT thickness on outcomes of radiofrequency catheter ablation of atrial fibrillation (AF). However, data on the relationship between EAT thickness and outcome of cryoballoon-based pulmonary vein isolation (PVI) are lacking.
  
  
  OBJECTIVE
  In this study, we investigate the association between EAT thickness and AF recurrence after cryoballoon-based PVI.
  
  
  METHODS
  Patients with symptomatic paroxysmal or persistent AF despite ≥1 antiarrhythmic drug(s) were scheduled for cryoballoon-based PVI for AF per the recent recommendations. Periatrial, periventricular, and total EAT thickness measurements were obtained from preprocedural multidetector CT scans.
  
  
  RESULTS
  A total of 249 patients (55.6 ± 10.7 years; 48.2% male; 18.5% persistent AF) were involved in the study. Patients were followed-up for 29 months (8-48 months). When blanking period was considered, freedom from AF after the ablation procedure was 75.9% at a median follow-up of 29 months. Total periatrial EAT thickness (18.1 ± 6.2 vs. 14.7 ± 4.7 mm; P < .001) was greater in patients with late AF recurrence when compared to those without. On the other hand, periventricular or total EAT thickness measurements did not differ between both groups (P > .05). Multivariate Cox proportional hazard regression analysis showed that periatrial EAT thickness (hazard ratio, 1.086; P = .001) and left atrial volume index (hazard ratio, 1.144; P < .001) were independent predictors for late AF recurrence.
  
  
  CONCLUSIONS
  Quantification of EAT thickness from preprocedural multidetector CT scans may serve as a beneficial parameter for prediction of AF recurrence after cryoballoon-based PVI.
authors.affiliation: Department of Cardiology, Hacettepe University Faculty of Medicine, Sihhiye, Ankara 06100, Turkey. Electronic address: kocyigitduygu@yahoo.com.
authors.forename: Duygu
authors.initials: D
authors.lastname: Kocyigit
authors.affiliation: Department of Cardiology, Konya Training and Research Hospital, Konya, Turkey.
authors.forename: Kadri Murat
authors.initials: KM
authors.lastname: Gurses
authors.affiliation: Department of Cardiology, Hakkari State Hospital, Hakkari, Turkey.
authors.forename: Muhammed Ulvi
authors.initials: MU
authors.lastname: Yalcin
authors.affiliation: Department of Radiology, Hacettepe University Faculty of Medicine, Ankara, Turkey.
authors.forename: Gamze
authors.initials: G
authors.lastname: Turk
authors.affiliation: Department of Cardiology, Hacettepe University Faculty of Medicine, Sihhiye, Ankara 06100, Turkey.
authors.forename: Banu
authors.initials: B
authors.lastname: Evranos
authors.affiliation: Department of Cardiology, Hacettepe University Faculty of Medicine, Sihhiye, Ankara 06100, Turkey.
authors.forename: Hikmet
authors.initials: H
authors.lastname: Yorgun
authors.affiliation: Department of Cardiology, Hacettepe University Faculty of Medicine, Sihhiye, Ankara 06100, Turkey.
authors.forename: Mehmet Levent
authors.initials: ML
authors.lastname: Sahiner
authors.affiliation: Department of Cardiology, Hacettepe University Faculty of Medicine, Sihhiye, Ankara 06100, Turkey.
authors.forename: Ergun Baris
authors.initials: EB
authors.lastname: Kaya
authors.affiliation: Department of Radiology, Hacettepe University Faculty of Medicine, Ankara, Turkey.
authors.forename: Tuncay
authors.initials: T
authors.lastname: Hazirolan
authors.affiliation: Department of Cardiology, Hacettepe University Faculty of Medicine, Sihhiye, Ankara 06100, Turkey.
authors.forename: Lale
authors.initials: L
authors.lastname: Tokgozoglu
authors.affiliation: Department of Cardiology, Hacettepe University Faculty of Medicine, Sihhiye, Ankara 06100, Turkey.
authors.forename: Mehmet Ali
authors.initials: MA
authors.lastname: Oto
authors.affiliation: Department of Cardiology, Hacettepe University Faculty of Medicine, Sihhiye, Ankara 06100, Turkey.
authors.forename: Necla
authors.initials: N
authors.lastname: Ozer
authors.affiliation: Department of Cardiology, Hacettepe University Faculty of Medicine, Sihhiye, Ankara 06100, Turkey.
authors.forename: Kudret
authors.initials: K
authors.lastname: Aytemir
mesh_terms: D000273:Adipose Tissue / Q000000981:diagnostic imaging*; D001281:Atrial Fibrillation / Q000000981:diagnostic imaging* / Q000601:surgery*; D006328:Cardiac Catheterization / Q000379:methods; D003452:Cryosurgery / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006325:Heart Atria / Q000000981:diagnostic imaging; D006329:Heart Conduction System / Q000000981:diagnostic imaging / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D010496:Pericardium / Q000000981:diagnostic imaging; D011379:Prognosis; D011667:Pulmonary Veins / Q000000981:diagnostic imaging / Q000601:surgery*; D012008:Recurrence; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed / Q000379:methods*; D016896:Treatment Outcome
keywords: Ablation; Atrial fibrillation; Cardiac computed tomography; Epicardial adipose tissue; Outcome