title: Is epicardial fat depot associated with atrial fibrillation? A systematic review and meta-analysis.
abstract: Atrial fibrillation (AF) is the leading rhythm disorder in western countries. A direct relationship between left atrium (LA) enlargement and electromechanical remodelling has been established. A causative link between epicardial fat (EF), visceral adipose tissue deposited around the heart, and AF has been hypothesized. Several reports suggested the association between EF and the presence of AF. The aim of this study was to verify the relationship between AF and EF depot, performing a meta-analysis of observational case series studies.
  
  
  
  Studies were identified by searching electronic databases by two independent investigators using 'atrial fibrillation' and 'epicardial fat' as keywords. Comparisons between healthy participants and AF cases were performed using a random effect meta-analysis estimating standardized mean difference among comparison groups. Meta regression was used to address the effect given by potential biological and technical confounders. Through a search result of 502 articles, only 7 were selected to conduct the present study. The comparison between all AF with respect to healthy participants resulted in a 32.0 ml of EF difference (95% confidence interval (CI) = 21.5, 42.5) showing that EF volume is higher in AF cases. A statistical significant difference of EF was observed when comparing both persistent and paroxysmal AF subtypes with respect to healthy participants (EF difference 48.0 ml (95% CI = 25.2, 70.8) and 15.7 ml (95% CI = 10.1, 21.4) for persistent and paroxysmal, respectively). A significant EF difference resulted also when comparing persistent to paroxysmal AF subtypes (29.6 ml (95% CI = 12.7, 46.5)).
  
  
  
  The present work expands the strength of previously reported association between EF amount and atrial arrhythmia.
authors.affiliation: Department of Public Health, Experimental and Forensic Medicine, Unit of Biostatistics and Clinical Epidemiology, Unit of Hygiene, University of Pavia, Via Strada Nuova 65, 27100 Pavia, Italy.
authors.forename: Maddalena
authors.initials: M
authors.lastname: Gaeta
authors.affiliation: Department of Cardiology, IRCCS Policlinico San Donato, Piazza Edmondo Malan, 1, 20097 San Donato Milanese MI, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Bandera
authors.affiliation: Department of Public Health, Experimental and Forensic Medicine, Unit of Biostatistics and Clinical Epidemiology, Unit of Hygiene, University of Pavia, Via Strada Nuova 65, 27100 Pavia, Italy.
authors.forename: Federico
authors.initials: F
authors.lastname: Tassinari
authors.affiliation: Department of Public Health, Experimental and Forensic Medicine, Unit of Biostatistics and Clinical Epidemiology, Unit of Hygiene, University of Pavia, Via Strada Nuova 65, 27100 Pavia, Italy.
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Capasso
authors.affiliation: Department of Public Health, Experimental and Forensic Medicine, Unit of Biostatistics and Clinical Epidemiology, Unit of Hygiene, University of Pavia, Via Strada Nuova 65, 27100 Pavia, Italy.
authors.forename: Miriam
authors.initials: M
authors.lastname: Cargnelutti
authors.affiliation: Department of Public Health, Experimental and Forensic Medicine, Unit of Biostatistics and Clinical Epidemiology, Unit of Hygiene, University of Pavia, Via Strada Nuova 65, 27100 Pavia, Italy.
authors.forename: Gabriele
authors.initials: G
authors.lastname: Pelissero
authors.affiliation: Diabetology and Metabolic Diseases Unit, IRCCS Policlinico San Donato, Piazza Edmondo Malan, 1, 20097 San Donato Milanese MI, Italy.
authors.forename: Alexis Elias
authors.initials: AE
authors.lastname: Malavazos
authors.affiliation: Department of Public Health, Experimental and Forensic Medicine, Unit of Biostatistics and Clinical Epidemiology, Unit of Hygiene, University of Pavia, Via Strada Nuova 65, 27100 Pavia, Italy.|Centre of Excellence for Nutrition (CEN), North-West University, Hoffman street 11, 2520 Potchefstroom, South Africa.
authors.forename: Cristian
authors.initials: C
authors.lastname: Ricci
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001281:Atrial Fibrillation / Q000175:diagnosis* / Q000453:epidemiology*; D005260:Female; D006801:Humans; D050152:Intra-Abdominal Fat / Q000000981:diagnostic imaging*; D008297:Male; D008875:Middle Aged; D010496:Pericardium / Q000000981:diagnostic imaging*; D015995:Prevalence; D015203:Reproducibility of Results; D012307:Risk Factors; D012680:Sensitivity and Specificity; D013223:Statistics as Topic
keywords: Atrial fibrillation; Epicardial fat depot; Meta-analysis ; Risk 