Combination of Epicardial Adipose Tissue and Left Atrial Low-Voltage Areas Predicting Atrial Fibrillation Recurrence after Radiofrequency Ablation.

INTRODUCTION: Atrial fibrillation (AF) is a common arrhythmia, with radiofrequency catheter ablation (RFCA) being first-line therapy. However, the high rate of post-ablation recurrence necessitates the identification of predictors for recurrence risk. Left atrial low-voltage areas (LA-LVASs), reflecting atrial fibrosis, have been confirmed to be related to recurrence of AF. Recently, epicardial adipose tissue (EAT) has been studied due to its role in initiating and maintaining AF. In this study, we try to evaluate the significance of the combined use of left atrial epicardial adipose tissue (LA-EAT) and percentage of LA-LVAs (LA-LVAs%) for predicting the recurrence of AF. METHODS: A total of 387 patients with AF who had undergone RFCA for the first time were followed up for 1, 3, 6, and 12 months. They were divided into two groups: the recurrence group (n = 90) and the non-recurrence group (n = 297). Before the ablation, all patients underwent computed tomography angiography examination of the left atrium, and the LA-EAT was measured using medical software (Advantage Workstation 4.6, GE, USA). After circumferential pulmonary vein isolation, a three-dimensional mapping system was used to map the LA endocardium and evaluate the LA-LVAs in sinus rhythm. RESULTS: After a median follow-up of 10.2 months, 90 patients developed AF recurrence after RFCA. Compared to patients without recurrence, the volume of LA-EAT (33.45 ± 13.65 vs. 26.27 ± 11.38; p < 0.001) and the LA-LVAs% (1.60% [0%, 9.99%] vs. 0.00% [0%, 2.46%]; p < 0.001) was significantly higher. Multivariate analysis indicated that PersAF, LA-EAT volume, and LA-LVAs% were independent predictors. Compared to PersAF (AUC 0.628; specificity 0.646; sensitivity 0.609), LA-EAT volume (AUC 0.655; specificity 0.675; sensitivity 0.586), or LA-LVAs% (AUC 0.659; specificity 0.836; sensitivity 0.437), the combined use of LA-EAT volume and LA-LVAs% offers higher accuracy for predicting AF recurrence after ablation (AUC 0.738; specificity 0.761; sensitivity 0.621). CONCLUSION: The combined LA-EAT and LA-LVAs% can effectively predict the risk of AF recurrence after radiofrequency ablation.

Coronary Angiography-Derived Index of Microcirculatory Resistance Associated With New-Onset Atrial Fibrillation in Patients With STEMI.

BACKGROUND: Coronary angiography-derived index of microcirculatory resistance (caIMR) can effectively assess coronary microvascular dysfunction in patients with ST-segment elevation myocardial infarction (STEMI). This study aimed to explore the role of caIMR in the occurrence of new-onset atrial fibrillation (NOAF) in patients with STEMI. METHODS: This was a single-centre retrospective clinical observational study. Patients diagnosed with STEMI from September 2019 to December 2022 were included. caIMR was calculated using computational flow and pressure simulations. During admission, suspicious heart rhythm was recorded by electrocardiographic (ECG) monitoring, and NOAF was confirmed by an immediate 12-lead ECG. RESULTS: A total of 739 patients were enrolled, including 57 (7.7) with NOAF. caIMR was significantly correlated with microvascular obstruction (R = 0.604; P < 0.001) and infarct size (R = 0.514; P < 0.001). After adjusting for potential confounding factors, the results showed that caIMR (odds ratio 1.058, 95% confidence interval 1.035-1.083; P < 0.001) was an independent risk factor for NOAF in patients with STEMI. Receiver operating characteristic analysis showed that the area under the curve of caIMR for predicting NOAF was 0.716. Compared with the caIMR < 27.35 U group, the caIMR ≥ 27.35 U group had higher high-sensitivity troponin T and N-terminal pro-B-type natriuretic peptide levels. When caIMR was added to the model, the reclassification and discriminant abilities improved significantly. CONCLUSIONS: Higher caIMR was an independent risk factor for NOAF in patients with STEMI. The caIMR had high specificity and sensitivity for predicting NOAF in patients with STEMI. The integration of caIMR into clinical risk factors showed significantly increased predictability for NOAF in patients with STEMI.

Left atrial strain associated with interatrial block in patients with ST-segment elevation myocardial infarction.

Both interatrial block (IAB) and left atrium (LA) strain are associated with atrial arrhythmias in ST-segment elevation myocardial infarction (STEMI) patients, but the relationship between IAB and LA strain has not yet been reported. This study was to investigate the correlation between LA strain and IAB in STEMI patients. This is a single-center retrospective clinical observational study. The STEMI patients with primary percutaneous coronary intervention (pPCI) were enrolled, and all patients completed cardiac magnetic resonance (CMR). A standard 12-lead electrocardiogram (ECG) was recorded on the same day as CMR. IAB was measured by p duration on ECG at follow-up. 302 patients were enrolled, including 91 (30.1%) with IAB. The reservoir strain, conduit strain and booster strain were included in model 1, model 2 and model 3, respectively. In model 1, age (OR 1.025; 95%CI 1.003-1.047; p = 0.026), hypertension (OR 2.188; 95%CI 1.288-3.719; p = 0.004), and reservoir strain (OR 0.947; 95%CI 0.920-0.974; p < 0.001) were independent factors for IAB. In model 2, age (OR 1.031; 95%CI 1.009-1.053; p = 0.006), hypertension (OR 2.058; 95%CI 1.202-3.522; p = 0.008), RCA lesions (OR 1.797; 95%CI 1.036-3.113; p = 0.037), and conduit strain (OR 0.910; 95%CI 0.868-0.953; p < 0.001) were independent factors for IAB. In model 3, age (OR 1.022; 95%CI 1.001-1.045; p = 0.044), hypertension (OR 2.239; 95%CI 1.329-3.773; p = 0.002), and booster strain (OR 0.948; 95%CI 0.908-0.991; p = 0.019) were independent factors for IAB. With the lowest AIC and BIC values, model 2 was the best-fit model. LA strain associated with IAB in STEMI patients. The model including conduit strain was the best-fit one.

The predictive value of left atrium epicardial adipose tissue on recurrence after catheter ablation in patients with different types of atrial fibrillation.

BACKGROUND: A growing body of evidence supports that the left atrium epicardial adipose tissue (LA-EAT) is related to the occurrence and recurrence of atrial fibrillation (AF). The relationship between LA-EAT and the recurrence after radiofrequency catheter ablation (RFCA) in patients with different types of AF is still unclear. This study aims to evaluate the predictive value of LA-EAT on the recurrence of AF after RFCA in patients with different types of AF. METHODS: 301 AF patients who underwent RFCA for the first time were divided into the paroxysmal atrial fibrillation (PAF) group (n = 181) and the persistent atrial fibrillation (PersAF) group(n = 120), which were followed up at 3, 6, and 12 months. All patients underwent left atrial computed tomography angiography (CTA) examination before the operation, and LA-EAT was measured using software (Advantage Workstation4.6, GE, USA). RESULTS: After a median follow-up of 10.7 months, 73/301 patients (24.25%) had a recurrence of AF, including 43 /120(35.83%) patients with PersAF and 30/181(16.57%) patients with PAF. In multivariable Cox regression analysis, LA-EAT volume (OR = 1.053;95%CI: 1.024-1.083, p < 0.001), attenuation (OR = 0.949;95%CI:0.911-0.988, p = 0.012) and left atrial diameter (LAD) (OR = 1.063;95%CI:1.002-1.127，p = 0.043) were independent risk factors for recurrence in patients with PersAF but not in patients with PAF. CONCLUSION: LA-EAT volume and attenuation are independent risk factors for recurrence after RFCA in patients with PersAF.

Left atrial epicardial adipose tissue is associated with low voltage zones in the left atrium in patients with non-valvular atrial fibrillation.

Objective: Epicardial adipose tissue (EAT) is related to atrial fibrillation (AF), but the specific mechanism is still unclear. Left atrial (LA) low voltage zones (LVZ) can well reflect atrial fibrosis. This study investigated the relationship between EAT and LVZ in non-valvular AF (NVAF) patients. Methods: This observational study including patients with NVAF (n = 214) undergoing radiofrequency ablation (RFCA) for the first time in our hospital and 62 matched controls. The EAT volume and attenuation were measured by contrast-enhanced computed tomography. A three-dimensional mapping system was used to map the left atrial endocardium and evaluate LA-LVZ. Patients were divided into LVZ and non-LVZ groups according to the presence or absence of LVZ. Results: Patients with AF showed higher LA-EAT volume and lower attenuation value than controls (29.7 ± 11.2 cm3 vs. 20.9 ± 8.6 cm3, P = 0.021; -91.2 ± 5.6 HU vs. -88.7 ± 5.9 HU, P < 0.001). Compared with the group without LVZ, there were significant differences in age [65 (59-71) vs. 60 (52-69), P = 0.006], LAVI [75.1 ± 20.7 ml/m2 vs. 67.2 ± 20.9 ml/m2, P = 0.018], LA-EAT volume (34.8 ± 11.5 cm3 vs. 28.1 ± 10.6 cm3, P < 0.001) and LA-EAT attenuation (-93.9 ± 5.3 HU vs. -90.4 ± 5.5 HU, P < 0.001). Multivariate regression analysis showed that age (OR = 1.040; 95%CI: 1.001-1.078, P = 0.042), LAVI (OR = 1.019; 95%CI: 1.002-1.037, P = 0.032), LA-EAT volume (OR = 1.193; 95%CI: 1.015-1.402, P = 0.034) and attenuation value (OR = 0.801; 95%CI: 0.701-0.916 P = 0.001) were independent predictors of LVZ. After LA-EAT attenuation was incorporated into the clinical model, the comprehensive discrimination and net reclassification tended to improve (IDI and NRI > 0, P < 0.05). Conclusion: LA-EAT volume and attenuation values can independently predict the presence of LVZ, and LA-EAT attenuation has a better predictive value than LA-EAT volume.

Left atrial epicardial adipose tissue is closely associated with left atrial appendage flow velocity in patients with nonvalvular atrial fibrillation.

Epicardial adipose tissue (EAT) can play an important role in the occurrence and development of atrial fibrillation and stroke. In this study, we explored the relationship between left atrial epicardial adipose tissue (LA-EAT) and left atrial appendage flow velocity (LAA-FV) in patients with nonvalvular atrial fibrillation (NV-AF). A total of 145 patients with NV-AF who underwent their first radiofrequency ablation were enrolled. They underwent left aortopulmonary vein computed tomography angiography (CTA) and transesophageal echocardiography (TEE) before AF ablation. Left atrial (LA) electroanatomical mapping was performed intraoperatively to assess left atrial voltage. Univariate regression analysis showed that LAA-FV was lower in patients with a low voltage zone (LAA-FV; 35.02 ± 10.78 cm/s vs. 50.60 ± 12.17 cm/s, P < 0.001). A multiple linear regression model showed that the left atrial low voltage zone (ß = - 0.311 P < 0.001), LA-EAT volume (ß = - 0.256 P < 0.001), left atrial appendage shape (ß = - 0.216 P = 0.041), LAVI (ß = - 0.153 P = 0.041), and type of atrial fibrillation (paroxysmal vs. persistence) (ß = - 0.146 P < 0.048) were independent predictors of LAA-FV. In NV-AF patients, the increase in LA-EAT volume is related to the decrease in LAA-FV.