title: The Impact of Echocardiographic Epicardial Fat Thickness on Outcomes of Cryoballoon-Based Atrial Fibrillation Ablation.
abstract: BACKGROUND
  Evidence from previous studies indicates increased epicardial fat volume, measured using computerized tomography, is significantly associated with recurrence of atrial fibrillation (AF) after catheter ablation. This association is most frequently linked to pro-inflammatory cytokine release from epicardial fat tissue. However, there is little data regarding the role of echocardiographically measured epicardial fat thickness (EFT) on catheter ablation outcomes. We aimed to investigate the predictive value of echocardiographically measured EFT on AF recurrence after cryoballoon-based catheter ablation.
  
  
  METHODS
  A total of 234 patients (51.3% male; mean age, 54.0 ± 10.9 years; 81.2% paroxysmal AF) with symptomatic AF underwent an initial cryoablation procedure. EFT was measured from the parasternal long-axis view at end-systole. A 3-month postablation blanking period was observed.
  
  
  RESULTS
  At a median follow-up of 20 (IQR: 13-24) months, 45 patients (19.2%) had developed AF recurrence. EFT thickness was significantly higher among patients with AF recurrence (7.79 ± 2.0 vs. 5.79 ± 1.38, P < 0.001) and was positively correlated with hs-CRP levels (r = 0.381, P < 0.001). Multivariate regression analysis showed EFT (HR: 1.36, 95% CI: 1.10-1.66, P = 0.004), left atrial diameter, and early AF recurrence were independent predictors of AF recurrence. Using a cutoff level of 6.92, preprocedural EFT predicted AF recurrence during follow-up with a sensitivity of 71.1% and specificity of 78.3% (AUC: 0.79; 95% CI: 0.71-0.87, P < 0.001).
  
  
  CONCLUSIONS
  Echocardiographically measured EFT independently predicted the AF recurrence after cryoablation and was also positively correlated with hs-CRP as an indicator for systemic inflammation. Thus, the association of echocardiographically measured EFT with AF recurrence may be linked to systemic inflammation.
authors: Department of Cardiology, Hacettepe University Faculty of Medicine, Ankara, Turkey.
authors: Uğur
authors: U
authors: Canpolat
authors: Department of Cardiology, Hacettepe University Faculty of Medicine, Ankara, Turkey.
authors: Kudret
authors: K
authors: Aytemir
authors: Department of Cardiology, Hacettepe University Faculty of Medicine, Ankara, Turkey.
authors: Hikmet
authors: H
authors: Yorgun
authors: Department of Cardiology, Hacettepe University Faculty of Medicine, Ankara, Turkey.
authors: Serkan
authors: S
authors: Asil
authors: Department of Cardiology, Hacettepe University Faculty of Medicine, Ankara, Turkey.
authors: Muhammed
authors: M
authors: Dural
authors: Department of Cardiology, Hacettepe University Faculty of Medicine, Ankara, Turkey.
authors: Necla
authors: N
authors: Özer
mesh_terms: D055011:Ablation Techniques / Q000706:statistics & numerical data; D000273:Adipose Tissue / Q000000981:diagnostic imaging* / Q000473:pathology; D001281:Atrial Fibrillation / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000601:surgery*; D017679:Cryotherapy / Q000706:statistics & numerical data*; D004452:Echocardiography / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009929:Organ Size; D010496:Pericardium / Q000000981:diagnostic imaging* / Q000473:pathology; D015995:Prevalence; D011379:Prognosis; D015203:Reproducibility of Results; D012307:Risk Factors; D012680:Sensitivity and Specificity; D016896:Treatment Outcome; D014421:Turkey / Q000453:epidemiology
keywords: atrial fibrillation; epicardial fat; inflammation; recurrence