Epicardial Adipose Tissue Thickness as a Predictor of Early Arrhythmia Recurrence After Electrical Cardioversion

Q: What is the clinical evidence from this study?

Study design: Observational. Population: Atrial fibrillation or atrial flutter undergoing electrical cardioversion (n=124). Intervention: Epicardial adipose tissue (EAT) thickness assessed via transthoracic echocardiography vs. Patients without early arrhythmia recurrence vs patients with recurrence. Primary outcome: Mean epicardial adipose tissue (EAT) thickness (mm) by early arrhythmia recurrence at 1 month (p=0.973).

Fabio Kadum; Koraljka Benko; Ana Petretić

doi:10.15836/ccar2026.225

November 1, 2026Cardiologia CroaticaOpen Access

Epicardial Adipose Tissue Thickness as a Predictor of Early Arrhythmia Recurrence After Electrical Cardioversion

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Key result

Epicardial adipose tissue thickness fails to predict 1-month arrhythmia recurrence after electrical cardioversion.

P=0.973
n=124

Why the study?

Does transthoracic echocardiographically assessed epicardial adipose tissue thickness predict early arrhythmia recurrence at one month in patients undergoing successful elective electrical cardioversion for atrial fibrillation or atrial flutter?

Key Points

To determine whether echocardiographic epicardial adipose tissue (EAT) thickness predicts early atrial arrhythmia recurrence at one month following successful electrical cardioversion.
Single-center observational analysis of 124 patients (54 with heart failure) who underwent successful elective electrical cardioversion for atrial fibrillation or atrial flutter.
Pre-procedural EAT thickness was assessed via transthoracic echocardiography, and early arrhythmia recurrence was determined by electrocardiography at one-month follow-up.
Multivariable logistic regression adjusted for EAT thickness, body mass index, left atrial size, and heart failure status.
Arrhythmia recurrence occurred in 29 of 124 patients (23.4%) at one month, with mean EAT thickness of 3.62 ± 1.74 mm in patients with recurrence versus 3.64 ± 1.76 mm without recurrence (p = 0.973; AUC = 0.502).
In the heart failure subgroup, recurrence occurred in 14 of 54 patients (25.9%), with no significant difference in EAT thickness between those with and without recurrence (3.64 ± 1.45 vs. 4.13 ± 1.86 mm, respectively; p = 0.456; AUC = 0.433).
Greater left atrial size was independently associated with recurrence (adjusted OR = 2.35; p = 0.015).

Study Design

Type

Observational (n=124)

Multicenter

No

Structured PICO

Does transthoracic echocardiographically assessed epicardial adipose tissue thickness predict early arrhythmia recurrence at one month in patients undergoing successful elective electrical cardioversion for atrial fibrillation or atrial flutter?

P

Population

124 patients with atrial fibrillation or atrial flutter (including 54 with heart failure) who underwent successful elective electrical cardioversion, free of intracardiac thrombi, followed for 1 month.

E

Exposure

Transthoracic echocardiography (TTE) assessment of epicardial adipose tissue (EAT) thickness prior to elective electrical cardioversion

O

Outcome

Early arrhythmia recurrence (AF or atrial flutter) evaluated by electrocardiography at the one-month follow-upsurrogate

Main Result

Absolute Event Rate: 3.62% vs 3.64%

p-value: p=0.973

Echocardiographically measured epicardial adipose tissue thickness does not predict 1-month arrhythmia recurrence after electrical cardioversion for atrial fibrillation or flutter, whereas left atrial enlargement is independently predictive.

Limitations

Single-center observational design
Conventional echocardiographic measurement of EAT thickness may not adequately capture complex epicardial adiposity compared to volumetric imaging techniques
Single-center observational analysis
Conventional echocardiographic measurement of EAT thickness may not adequately capture the complex relationship between epicardial adiposity and atrial arrhythmogenesis compared to volumetric imaging techniques

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Answers are grounded in this paper and cite their sources.

Implication

Does not support epicardial adipose tissue thickness for post-cardioversion recurrence prediction; leaves open its value in larger prospective cohorts.

Abstract

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Discussion

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Cite This Study

Kadum et al. (2026) conducted an observational in Atrial fibrillation or atrial flutter undergoing electrical cardioversion (n=124). Epicardial adipose tissue (EAT) thickness assessed via transthoracic echocardiography vs. Patients without early arrhythmia recurrence vs patients with recurrence was evaluated on Mean epicardial adipose tissue (EAT) thickness (mm) by early arrhythmia recurrence at 1 month (p=0.973). Epicardial adipose tissue thickness did not predict 1-month arrhythmia recurrence after electrical cardioversion.

synapsesocial.com/papers/6af5db4d0766bb45ea00311a https://doi.org/10.15836/ccar2026.225

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Epicardial Adipose Tissue Thickness as a Predictor of Early Arrhythmia Recurrence After Electrical Cardioversion

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Epicardial Adipose Tissue Thickness as a Predictor of Early Arrhythmia Recurrence After Electrical Cardioversion

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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