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September 18, 2026Heart Rhythm

Epicardial adipose tissue predicts local bipolar voltage and posterior-to-LA EAT ratio predicts atrial arrhythmia recurrence.

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Why the study?

Does epicardial adipose tissue predict atrial substrate distribution and arrhythmia recurrence in patients with early atrial remodeling undergoing AF ablation?

Population

50 patients undergoing index atrial fibrillation ablation with early atrial remodeling, mean age 56±11…

Design

Cohort

Key result

Epicardial adipose tissue presence significantly predicted local bipolar voltage (p=0.010), and the posterior-to-LA EAT ratio independently predicted atrial arrhythmia recurrence.

Authors

MLMichael LimSPSirish Chandra Srinath PatlooriASAdrian Suszko

Discussion

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Overview

May refine recurrence risk stratification before AF ablation; hypothesis-generating for EAT in early remodeling, pending prospective validation.

Key Points

  • To evaluate the spatial relationship between left atrial epicardial adipose tissue, local unipolar and bipolar voltages, and post-ablation arrhythmia recurrence in early atrial remodeling.
  • Enrolled 50 consecutive patients (mean age 56±11 years, 78% paroxysmal AF) undergoing index catheter ablation, excluding those with extensive bipolar low-voltage areas (≥5%).
  • Conducted high-resolution left atrial electroanatomic mapping to correlate unipolar and bipolar voltages with epicardial adipose tissue distribution.
  • Unipolar voltage thresholds identified scar in an additional 9.2% of tissue points that exhibited preserved bipolar voltages.
  • Epicardial adipose tissue presence significantly predicted local bipolar voltage (p=0.010), demonstrating the strongest correlation on the posterior wall for unipolar (p=0.027) and bipolar (p=0.007) voltage.
  • The posterior wall to left atrial epicardial adipose tissue ratio was the only independent predictor of atrial arrhythmia recurrence among paroxysmal AF patients.

Study Design

Type

Cohort (n=50)

Structured PICO

Does epicardial adipose tissue predict atrial substrate distribution and arrhythmia recurrence in patients with early atrial remodeling undergoing AF ablation?

P
Population
50 patients (mean age 56, 78% paroxysmal AF) with early atrial remodeling undergoing index AF ablation.
E
Exposure
Assessment of left atrial epicardial adipose tissue (EAT) and high-resolution left atrial electroanatomic mapping (unipolar and bipolar voltage).
O
Outcome
Relationship between left atrial EAT, local unipolar and bipolar voltage, and post-ablation arrhythmia recurrence.surrogate

Main Result

p-value: p=0.010

Epicardial adipose tissue, particularly on the posterior wall, predicts early atrial substrate development and arrhythmia recurrence in patients undergoing initial AF ablation.

Cite This Study

Lim et al. (2026) conducted a cohort in Early atrial remodeling in atrial fibrillation (n=50). Epicardial adipose tissue (EAT) was evaluated on Local bipolar voltage (p=0.010). Epicardial adipose tissue presence significantly predicted local bipolar voltage (p=0.010), and the posterior-to-LA EAT ratio independently predicted atrial arrhythmia recurrence.

synapsesocial.com/papers/6aacf6b60c46fbdff987ddb3https://doi.org/10.1016/j.hrthm.2026.09.017
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