Combination Epicardial Adipose Tissue and left atrial Low Voltage Areas Predicting Atrial Fibrillation Recurrence after radiofrequency ablation

Background: Atrial fibrillation (AF) is a common arrhythmia, with radiofrequency catheter ablation (RFCA) being first-line therapy. However, the high rate of post-ablation recurrence necessitates the identification of predictors for recurrence risk. Left atrial low-voltage areas (LA-LVASs), reflecting atrial fibrosis, have been confirmed to be related to recurrence of atrial fibrillation. Recently, epicardial adipose tissue (EAT) has been studied due to its role in initiating and maintaining atrial fibrillation. In this study, we try to evaluate the significance of the combined use of LA-EAT and percentage of LA-LVAs (LA-LVAs%) for predicting the recurrence of atrial fibrillation. Methods: A total of 387 patients with AF who had undergone RFCA for the first time were followed up for 3, 6, and 12 months. They were divided into two groups: the recurrence group (n=90) and the non-recurrence group (n=297). Before the ablation, all patients underwent computed tomography angiography (CTA) examination of the left atrium, and the left atrial epicardial adipose tissue (LA-EAT) was measured using medical software (Advantage Workstation 4.6, GE, USA). After circumferential pulmonary vein isolation， a three-dimensional mapping system was used to map the left atrial endocardium and evaluate the LA-LVAs in sinus rhythm. Results: After a median follow-up of 10.2 months, 90 patients developed AF recurrence after RFCA. Compared to patients without recurrence, the volume of LA-EAT (33.45±13.65 vs. 26.27±11.38; p<0.001) and the LA-LVAs% (1.60% (0%, 9.99%) vs. 0.00% (0%, 2.46%); p<0.001) were significantly higher. Multivariate analysis indicated that non-paroxysmal AF, LA-EAT volume, and LA-LVAs% were independent predictors. Compared to LA-EAT volume (AUC 0.655; specificity 0.675; sensitivity 0.586) or LA-LVAs% (AUC 0.659; specificity 0.836; sensitivity 0.437), the combined use of LA-EAT volume and LA-LVAs% offers higher accuracy for predicting AF recurrence after ablation (AUC 0.738; specificity 0.761; sensitivity 0.621). Conclusion: The combined LA-EAT and LA-LVAs% can effectively predict the risk of AF recurrence after radiofrequency ablation.