Periatrial Fat Quality Predicts Atrial Fibrillation Ablation Outcome

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Symptomatic, drug-refractory atrial fibrillation referred for first catheter ablation (n=143). Intervention: Left atrial periatrial fat quality (mean CT attenuation in 4-chamber view) vs. Lower LA periatrial fat attenuation ( 30 seconds after a 3-month blanking period) (HR 2.65, p=0.001).

Luisa Ciuffo; Hieu Nguyen; Mateus Diniz Marques; Konstantinos N. Aronis; Bhradeev Sivasambu; Henrique Doria de Vasconcelos; Susumu Tao; David Spragg; Joseph E. Marine; Ronald D. Berger; João A.C. Lima; Hugh Calkins; Hiroshi Ashikaga

doi:10.1161/circimaging.118.008764

June 1, 2019Circulation Cardiovascular ImagingOpen Access

Periatrial Fat Quality Predicts Atrial Fibrillation Ablation Outcome

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Key result

Higher left atrial periatrial fat attenuation linked to ~2.6-fold higher AF recurrence after catheter ablation.

HR 2.65
P=0.001
n=143

Why the study?

While left atrial periatrial fat quantity predicts recurrence after AF ablation, whether fat quality assessed by computed tomography attenuation predicts recurrence independently was unknown.

Does left atrial periatrial fat quality measured by pre-ablation CT attenuation predict arrhythmia recurrence in patients with drug-refractory atrial fibrillation undergoing first catheter ablation?

Key Points

To determine whether the quality of left atrial periatrial fat tissue, assessed via mean computed tomography attenuation, predicts recurrence following catheter ablation for atrial fibrillation independent of fat quantity.
Analyzed 143 consecutive patients with drug-refractory atrial fibrillation (mean age 62.2±10 years, 40% nonparoxysmal atrial fibrillation) referred for first catheter ablation.
Performed preablation cardiac computed tomography, measuring left atrial periatrial fat quantity by area (mm²) and quality by mean attenuation (Hounsfield units) in a standard 4-chamber view.
Patients with atrial fibrillation recurrence (n=57) demonstrated significantly larger fat area (167.6 [IQR, 124.1–255] vs. 145.4 [IQR, 95.6–229.3] mm²; P=0.018) and higher fat attenuation (−92.0±9.8 vs. −96.5±9.4 Hounsfield units; P=0.006) than controls.
Higher left atrial fat attenuation independently predicted arrhythmia recurrence after adjusting for body mass index, atrial fibrillation type, left atrial dimension, and fat area (HR, 2.65; P=0.001).

Study Design

Type

Cohort (n=143)

Blinding

Operator responsible for the imaging analysis was blinded to AF outcomes

Multicenter

No

Structured PICO

Does left atrial periatrial fat quality measured by pre-ablation CT attenuation predict arrhythmia recurrence in patients with drug-refractory atrial fibrillation undergoing first catheter ablation?

P

Population

143 adults (mean age 62.2 years, 36.4% female) with symptomatic, drug-refractory atrial fibrillation (40% nonparoxysmal) undergoing first catheter ablation with pre-procedural cardiac CT, followed for at least 12 months.

E

Exposure

Pre-ablation cardiac CT assessment of left atrial (LA) periatrial fat quality (measured by mean CT attenuation in Hounsfield units in a standard 4-chamber view) and quantity (area in mm²), prior to standard pulmonary vein isolation (PVI) catheter ablation using radiofrequency or cryoballoon.

C

Comparator

Patients without AF recurrence after ablation (n=86 controls) vs patients with AF recurrence (n=57), or lower 4-chamber LA periatrial fat attenuation (< -86.98 HU).

O

Outcome

Atrial fibrillation recurrence, defined as any documented episodes of AF, atrial flutter, or atrial tachycardia lasting more than 30 seconds after a 3-month blanking period, evaluated up to 12 months after ablation.hard clinical

Main Result

Hazard Ratio: 2.65

p-value: p=0.001

Limitations

Single-center analysis of patients referred for catheter ablation of AF with non-negligible chance of selection bias
Definition of recurrence was strongly influenced by symptoms, potentially missing asymptomatic recurrence
Fat analysis used only two- and four-chamber views, potentially underestimating LA fat in regions not covered
Outcomes were evaluated only up to 12 months after ablation
Lack of external validation outside the included population
Observational study design where unmeasured confounding cannot be excluded
Single-center analysis with potential selection bias
Recurrence definition was strongly influenced by symptoms, potentially missing asymptomatic recurrence
Fat analysis used only 2-chamber and 4-chamber views, potentially missing uncovered LA fat regions
Outcomes evaluated only up to 12 months after ablation
Lack of external validation
Observational study with potential unmeasured confounding

Implication

Pre-ablation assessment of left atrial periatrial fat quality via CT attenuation on a single 4-chamber slice independently predicts AF recurrence after first catheter ablation, offering a simple metric to refine patient selection.

Abstract

Background: Previous studies showed that the quantity of the left atrial (LA) periatrial fat tissue predicts recurrence after catheter ablation of atrial fibrillation (AF). We hypothesized that the quality of the LA periatrial fat tissue, measured by the mean computed tomography attenuation, predicts recurrence after AF ablation independent of the quantity of the LA periatrial fat tissue. Methods: We included 143 consecutive patients with drug-refractory AF referred for the first catheter ablation of AF (62.2±10 years, 40% nonparoxysmal AF). All participants had a preablation cardiac computed tomography. We measured the quantity of the LA periatrial fat tissue by the area (millimeter square) and the quality by the mean computed tomography attenuation (Hounsfield units) in a standard 4-chamber view. Results: Patients with AF recurrence after ablation (n=57) had a significantly larger fat area (167.6 [interquartile range, 124.1–255] versus 145.4 [95.6–229.3] mm 2 ; P =0.018) and a higher fat attenuation (−92.0±9.8 versus −96.5±9.4 Hounsfield units; P =0.006) than those without recurrence (controls). LA fat attenuation was correlated with LA fat volume and LA bipolar voltage by invasive mapping and was associated with AF recurrence after adjusting for clinical risk factors, including body mass index, AF type, LA dimension, and fat area (hazard ratio, 2.65; P =0.001). Conclusions: The quality of the LA periatrial fat tissue is an independent predictor of recurrence after the first AF ablation. Assessment of LA periatrial fat attenuation can improve AF ablation outcomes by refining patient selection.

Discussion

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Cite This Study

Ciuffo et al. (2019) conducted a cohort in Symptomatic, drug-refractory atrial fibrillation referred for first catheter ablation (n=143). Left atrial periatrial fat quality (mean CT attenuation in 4-chamber view) vs. Lower LA periatrial fat attenuation (< -86.98 HU) or patients without AF recurrence was evaluated on Atrial fibrillation recurrence (documented episodes of AF, atrial flutter, or atrial tachycardia lasting >30 seconds after a 3-month blanking period) (HR 2.65, p=0.001). Left atrial periatrial fat CT attenuation independently predicted AF recurrence after first catheter ablation after multivariable adjustment (HR 2.65; P=0.001).

synapsesocial.com/papers/6a733a304a79f4a92c4b2053 https://doi.org/10.1161/circimaging.118.008764

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Periatrial Fat Quality Predicts Atrial Fibrillation Ablation Outcome

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

Periatrial Fat Quality Predicts Atrial Fibrillation Ablation Outcome

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

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