The association between epicardial adipose tissue thickness around the right ventricular free wall evaluated by transthoracic echocardiography and left atrial appendage function

The influence of epicardial adipose tissue on the prognosis of atrial fibrillation patients undergoing radiofrequency ablation combined with left atrial appendage occlusion

Atrial fibrillation is the most common arrhythmia in adults. The interplay between epicardial adipose tissue and atrial fibrillation has garnered significant scientific interest. Recently, the combined approach of radiofrequency ablation and left atrial appendage occlusion has become a widely adopted strategy for managing non-valvular atrial fibrillation patients at high risk of thrombus formation. This study aims to assess the prognostic significance of epicardial adipose tissue volume in patients undergoing radiofrequency ablation in conjunction with left atrial appendage occlusion. This study results indicate that in patients undergoing the one-stop procedure, which comprises catheter radiofrequency ablation and percutaneous left atrial appendage occlusion, epicardial adipose tissue volume is significantly associated with AF recurrence post-strategy. Higher EATV predicts AF recurrence (HR = 1.17, 95%CI1.047-1.192, P = 0.001) and thromboembolism (P = 0.002) following the one-stop procedure. Epicardial adipose tissue volume serves as a significant predictor of atrial fibrillation recurrence following the one-stop procedure (area under the curve 0.648, 95%CI0.571-0.725, P = 0.002, sensitivity 0.88, specificity 0.50).

The role of epicardial adipose tissue dysfunction in cardiovascular diseases: an overview of pathophysiology, evaluation, and management

In recent decades, the epicardial adipose tissue (EAT) has been at the forefront of scientific research because of its diverse role in the pathogenesis of cardiovascular diseases (CVDs). EAT lies between the myocardium and the visceral pericardium. The same microcirculation exists both in the epicardial fat and the myocardium. Under physiological circumstances, EAT serves as cushion and protects coronary arteries and myocardium from violent distortion and impact. In addition, EAT acts as an energy lipid source, thermoregulator, and endocrine organ. Under pathological conditions, EAT dysfunction promotes various CVDs progression in several ways. It seems that various secretions of the epicardial fat are responsible for myocardial metabolic disturbances and, finally, leads to CVDs. Therefore, EAT might be an early predictor of CVDs. Furthermore, different non-invasive imaging techniques have been proposed to identify and assess EAT as an important parameter to stratify the CVD risk. We also present the potential therapeutic possibilities aiming at modifying the function of EAT. This paper aims to provide overview of the potential role of EAT in CVDs, discuss different imaging techniques to assess EAT, and provide potential therapeutic options for EAT. Hence, EAT may represent as a potential predictor and a novel therapeutic target for management of CVDs in the future.

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 (β = - 0.311 P < 0.001), LA-EAT volume (β = - 0.256 P < 0.001), left atrial appendage shape (β = - 0.216 P = 0.041), LAVI (β = - 0.153 P = 0.041), and type of atrial fibrillation (paroxysmal vs. persistence) (β = - 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.