The Role of Epicardial Adipose Tissue in the Development of Atrial Fibrillation: A Systematic Review and Meta-Analysis

Background: Atrial fibrillation (AF) is the most frequent arrhythmia worldwide that significantly elevates stroke and heart failure risks. Recent developments in imaging research have shown the need for exploring epicardial adipose tissue (EAT) as a contributor to atrial pathology. Methods: Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and registered in PROSPERO (CRD42022360443), a systematic search was conducted across PubMed, Scopus and Google Scholar using terms related to AF and EAT quantified using computed tomography. Inclusion criteria encompassed in vivo studies assessing EAT’s effect on AF, with reported outcomes including AF development. Publication bias was assessed through two complementary approaches: visual inspection of funnel plot symmetry and formal statistical testing using Egger’s or Begg’s tests. A two-tailed P value threshold of 0.05 was established for determining statistical significance throughout all analyses. Results: Ten studies (851 patients) analyzed showed the relationship between total EAT and AF. Meta-analysis of aggregate data revealed a statistically significant standardized mean difference (SMD) of 0.70 (95% confidence interval (CI), 0.24–1.15; I2 = 91%; P < 0.01). Seven studies (579 patients) analyzed the relationship between periatrial EAT and AF. Meta-analysis of aggregate data revealed a statistically significant SMD of 1.13 (95% CI, 0.49–1.78; I2 = 91%; P < 0.01). Conclusions: This meta-analysis demonstrates that total and periatrial EAT correlate with AF; however, periatrial EAT has a more convincing association with AF than total EAT.