Epicardial Adipose Tissue Volume Adjacent to Left Atrium Predicts the Reccurence of Atrial Fibrillation after PV Isolation Plus Ganglionated Plexus Ablation

Clinical studies described the addition of ganglionated plexus (GP) ablation enhancing the efficacy of pulmonary vein isolation (PVI) for atrial fibrillation (AF) and contribution of epicardial adipose tissue (EAT) containing GP to AF initiation has been reported for its autonomic modulation. The aim of this study was to determine the amount of EAT surrounding the left atrium (LA) correlate with recurrence of AF after PVI plus GP ablation (GP-ABL). 17 patients with paroxysmal AF (age 58±10 years, BMI 24.1±2.2) underwent GP-ABL and PVI. The selective GP-ABL guided by localization using endocardial high frequency stimulation showing a vagal response. Total volume of EAT (EAT-total) and EAT volume around the LA (EAT-LA) were identified by threshold setting of −30 to 200 Hounsfield units in multi-slice computed tomography measurement, compared between 8 pts with AF recurrence (AF-Rec) and 9 pts without AF recurrence (No-Rec) during follow-up months of 6±4. Despite the similar BMI (23.4±2.2 vs 24.8±2.2) in both group, AF-Rec had a significantly greater EAT-LA than No-Rec (2.6±1.2 vs 0.9±0.4 cm3, p<0.01), and EAT-total, the distribution of EAT as EAT-LA/EAT-total were increased (82.5±33.9 vs 59.0±50.4 cm3, p=0.27, 3.0±1.1 vs 2.0±1.0%, p=0.07) in AF-Rec. In conclusion, evaluation of EAT-LA can distinguish the AF recurrence after PVI plus GP-ABL.