What is the clinical evidence from this study?

Study design: Meta-Analysis. Population: Atrial fibrillation (n=1840). Intervention: Epicardial adipose tissue (EAT) amount vs. Lower EAT amount. Primary outcome: Atrial fibrillation recurrence after catheter ablation (RR 1.06, 95% CI 1.02-1.11, p=0.005).

June 11, 2022Open Access

Epicardial adipose tissue is associated with higher recurrence risk after catheter ablation in atrial fibrillation patients: a systematic review and meta-analysis

JCJun ChenZhejiang Chinese Medical University ZMZiwei MeiState Grid Corporation of China (China)YYYang YangShandong University

Key Result

Higher epicardial adipose tissue amount was significantly associated with an increased risk of atrial fibrillation recurrence after catheter ablation (RR 1.06).

Study Design

Type

Meta-Analysis (n=1,840)

Structured PICO

Does higher epicardial adipose tissue increase atrial fibrillation recurrence in patients undergoing catheter ablation?

Population

1,840 patients with atrial fibrillation undergoing catheter ablation from 10 retrospective cohort studies, followed for at least 6 months to assess recurrence.

Exposure

Higher epicardial adipose tissue (EAT) amount, thickness, or volume measured by computed tomography (CT) or echocardiography.

Comparator

Lower epicardial adipose tissue (EAT) amount, thickness, or volume.

Outcome

Atrial fibrillation recurrence after catheter ablation.

Increased epicardial adipose tissue, particularly EAT thickness, is significantly associated with a higher risk of atrial fibrillation recurrence following catheter ablation.

Main Result

Relative Risk: 1.06 (95% CI 1.02–1.11)

p-value: p=0.005

Limitations

All included studies were retrospective, which may introduce bias compared to prospective cohort studies.
Presence of publication bias in the meta-analysis.
Small sample sizes in individual included studies.
High clinical heterogeneity among the included studies.

Abstract

OBJECTIVE: Our study aimed to investigate the association between epicardial adipose tissue (EAT) and atrial fibrillation (AF) recurrence risk after catheter ablation. METHODS: We searched PubMed, Embase, and Cochrane Library databases up to November 30, 2021 without language restrictions. Outcome was the relative risk (RR) of EAT contributes to AF recurrence after catheter ablation. The RR and 95% confidence interval (CI) was pooled by the random-effect model. RESULTS: 10 studies that contained 1840 AF patients were included in our study. The result of this study showed that EAT amount was associated with higher risk of AF recurrence after catheter ablation (RR = 1.06, 95% CI 1.02-1.11, P = 0.005) and EAT related thickness was a risk factor for AF recurrence after catheter ablation (RR = 1.73, 95% CI 1.04-2.87, P = 0.040). Sub-analysis showed that EAT was strongly associated with higher risk of AF recurrence common in Asian population (RR = 1.25, 95% CI 1.10-1.43, P < 0.001), patients aged ≤ 60 years old (RR = 2.01, 95% CI 1.18-3.44, P = 0.010), and follow-up more than 1 year (RR = 1.06, 95% CI 1.01-1.11, P = 0.020). CONCLUSION: The meta-analysis demonstrated that EAT related thickness seems to be the marker most strongly associated with a greater risk of AF recurrences after catheter ablation. It should be included into risk stratification for predicting AF recurrent before catheter ablation.

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