Epicardial adipose tissue in paroxysmal and persistent atrial fibrillation ablation using photon counting CT and automated 3D atrial segmentation: The Prospective AFAT Study

Q: What is the clinical evidence from this study?

Study design: Observational. Population: Paroxysmal and persistent atrial fibrillation (n=210). Intervention: Biatrial epicardial adipose tissue (EAT). Primary outcome: Freedom from any atrial arrhythmia at one year following an 8-week blanking period.

Q: What does this research mean for the field?

Left atrial epicardial adipose tissue quantified via photon-counting CT is associated with arrhythmia recurrence after catheter ablation in persistent atrial fibrillation, but not in paroxysmal atrial fibrillation. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Nico Erhard; Fabian Bahlke; S Prommersberger; Keno Bressem; Leonie Förschner; Florian Englert; Miruna Popa; Hannah Krafft; E Koops; Theresa Reiter; Dominic Dischel; Marta Telishevska; Sarah Lengauer; Martin Hadamitzky; Tilko Reents; Felix Bourier; Gabriele Hessling; Isabel Deisenhofer

doi:10.1016/j.hrthm.2026.09.019

Key result

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

n=210

Graphical abstract published by Heart Rhythm — Graphical abstract · Published by Heart Rhythm · CC BY 4.0

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?

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.

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Implication

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

Abstract

BACKGROUND: Epicardial adipose tissue (EAT) may contribute to atrial fibrillation (AF) pathogenesis and recurrence after catheter ablation, but data using precise volumetric quantification alongside systematic body composition assessment are limited. OBJECTIVE: To quantify biatrial EAT using photon-counting CT (PCCT) with semiautomated 3D segmentation and assess its association with arrhythmia recurrence after first-time catheter ablation in paroxysmal and persistent AF. METHODS: In this prospective observational study, 210 adults undergoing first-time catheter ablation at the German Heart Centre Munich underwent preprocedural PCCT with 3D biatrial EAT reconstruction and protocolized whole-body composition assessment. The primary endpoint was 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 months. CONCLUSION: PCCT enables precise biatrial EAT quantification. LA EAT was associated with arrhythmia recurrence in persistent but not paroxysmal AF, supporting its potential as an imaging biomarker.

Discussion

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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/6aae47cb0c69660b71ecc6eb https://doi.org/10.1016/j.hrthm.2026.09.019

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Epicardial adipose tissue in paroxysmal and persistent atrial fibrillation ablation using photon counting CT and automated 3D atrial segmentation: The Prospective AFAT Study

Key Points

Study Design

Structured PICO

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Epicardial adipose tissue in paroxysmal and persistent atrial fibrillation ablation using photon counting CT and automated 3D atrial segmentation: The Prospective AFAT Study

Key Points

Study Design

Structured PICO

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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