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September 19, 2026Heart RhythmOpen Access

Left atrial EAT is linked to arrhythmia recurrence in persistent but not paroxysmal AF.

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Why the study?

Epicardial adipose tissue may contribute to atrial fibrillation pathogenesis and recurrence after catheter ablation, but precise volumetric quantification data with systematic body composition assessment are limited.

Does epicardial adipose tissue quantified by photon-counting CT predict arrhythmia recurrence after first-time catheter ablation in patients with atrial fibrillation?

Population

210 adults undergoing first-time catheter ablation for paroxysmal and persistent AF

Comparison

Biatrial EAT quantification using photon-counting CT with 3D segmentation

Design

Prospective observational study at a single center

Key result

Left atrial epicardial adipose tissue was associated with arrhythmia recurrence at one year in patients with persistent, but not paroxysmal, atrial fibrillation.

Authors

NENico ErhardFBFabian BahlkeSPS Prommersberger

Discussion

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Overview

May inform recurrence risk counseling in persistent AF; leaves open whether epicardial adipose tissue quantification improves ablation outcomes.

Key Points

  • To measure biatrial epicardial adipose tissue using photon-counting CT and assess its link to arrhythmia recurrence following first-time catheter ablation for atrial fibrillation.
  • Prospective observational study including 210 adults undergoing first-time catheter ablation at a single center in Germany.
  • Patients underwent preprocedural photon-counting CT with semiautomated 3D biatrial epicardial adipose tissue reconstruction and systematic body composition assessment.
  • The primary endpoint was freedom from any atrial arrhythmia at one year following an 8-week blanking period, monitored using 7-day Holter tracking at 3, 6, and 12 months.
  • The study population had a median age of 68.0 years and a median body mass index of 27.0 kg/m².
  • Left atrial epicardial adipose tissue volume was significantly associated with arrhythmia recurrence after ablation in persistent atrial fibrillation, but not in paroxysmal atrial fibrillation.

Study Design

Type

Observational (n=210)

Multicenter

No

Structured PICO

Does epicardial adipose tissue quantified by photon-counting CT predict arrhythmia recurrence after first-time catheter ablation in patients with atrial fibrillation?

P
Population
210 adults undergoing first-time catheter ablation for paroxysmal and persistent atrial fibrillation, evaluated for biatrial epicardial adipose tissue and followed for 1 year.
E
Exposure
Preprocedural photon-counting CT (PCCT) with 3D biatrial epicardial adipose tissue (EAT) reconstruction and whole-body composition assessment
O
Outcome
Freedom from any atrial arrhythmia at one year following an 8-week blanking period, assessed by 7-day Holter monitoring at 3, 6 and 12 monthssurrogate

Left atrial epicardial adipose tissue quantified by photon-counting CT may serve as an imaging biomarker for predicting arrhythmia recurrence after catheter ablation in patients with persistent atrial fibrillation.

Cite This Study

Erhard et al. (2026) conducted an observational in Paroxysmal and persistent atrial fibrillation (n=210). Biatrial epicardial adipose tissue (EAT) was evaluated on Freedom from any atrial arrhythmia at one year following an 8-week blanking period. Left atrial epicardial adipose tissue was associated with arrhythmia recurrence at one year in patients with persistent, but not paroxysmal, atrial fibrillation.

synapsesocial.com/papers/6aae47cb0c69660b71ecc6ebhttps://doi.org/10.1016/j.hrthm.2026.09.019
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Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1Volumetric quantification of epicardial fat using semiautomated atrial CT segmentation in patients with atrial fibrillation: the Prospective AFAT study2024
  2. 2Prognostic value of epicardial adipose tissue parameters assessed by computed tomography in predicting atrial fibrillation ablation efficacy2025
  3. 3Quantification of epicardial adipose tissue in patients undergoing hybrid ablation for atrial fibrillation2018 · 22 citations
  4. 4Predictive Value of Epicardial Adipose Tissue Parameters Measured by Cardiac Computed Tomography for Recurrence of Atrial Fibrillation After Pulmonary Vein Isolation2025 · 2 citations
  5. 5Is There an Association between Epicardial Adipose Tissue and Outcomes after Paroxysmal Atrial Fibrillation Catheter Ablation?2021 · 29 citations