Key result
Periatrial EAT links more strongly to AF than total EAT.
Why the study?
Recent imaging research highlighted the need to explore epicardial adipose tissue as a contributor to atrial pathology in atrial fibrillation.
Does increased total and periatrial epicardial adipose tissue correlate with the development of atrial fibrillation?
Meta-Analysis (n=2,117)
Does increased total and periatrial epicardial adipose tissue correlate with the development of atrial fibrillation?
Effect estimate: SMD 0.70 for total EAT; SMD 1.13 for periatrial EAT (95% CI 0.24–1.15 for total EAT; 0.49–1.78 for periatrial EAT)
p-value: p=<0.01
Periatrial epicardial adipose tissue has a stronger and more convincing association with the development of atrial fibrillation than total epicardial adipose tissue.
Supports periatrial epicardial adipose tissue as preferred AF risk marker over total; extends meta-analytic evidence while remaining hypothesis-generating.
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.
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Тарзиманова et al. (2026) conducted a meta-analysis in Patients with idiopathic paroxysmal or persistent atrial fibrillation (n=2,117). Increased epicardial adipose tissue (EAT) volume vs. Lower epicardial adipose tissue volume was evaluated on Association between epicardial adipose tissue (total and periatrial) volume and presence of atrial fibrillation (SMD 0.70 for total EAT; SMD 1.13 for periatrial EAT, 95% CI 0.24–1.15 for total EAT; 0.49–1.78 for periatrial EAT, p=<0.01). Periatrial epicardial adipose tissue was more strongly associated with atrial fibrillation with a standardized mean difference of 1.13 compared to 0.70 for total epicardial adipose tissue in patients with AF.
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